Aesthetic outcome of my jaw surgery

[VincentGT]

I’m a 32-year-old male considering jaw surgery.  Well, I have decided already actually.

Here you find the CBCT scans of my face and skull. 

Here you find pictures of my face, in different lightings and positions. Taken by different surgeons.

And finally, here you can find a few morphs I made myself with the desired results. Not all of these are exactly the same or as good, but I believe they might give an idea what I’m looking for. 

I have seen a few surgeons and I finally decided who my surgeon would be. He was advised by many; I can’t find any negative review online and my orthodontist vouches for him too. 

Functional issues
I am a mouth breather; breathing through my nose is very hard and I can’t seem to make a habit of it. 
I am also diagnosed with mild sleep apnea and I experience vocal fatigue if I’m talking for extended periods, probably due to not breathing correctly.
I have had orthodontics 15+ years ago, which created a class I bite, but skeletal I’m still a class II.

Aesthetic issues
I have a weak jawline and recessed chin, a permanent double chin (because of the short mandible) and my nose appears larger than it actually is. I considered getting chin filler or a chin implant, but that would make my teeth relatively even ‘deeper’ in my face instead of bringing the jaws forward. With the chance of ending up with a witch chin, I didn’t follow through.

Most of the surgeons all said the same thing: I would benefit from bimax surgery. During camouflage orthodontics (15+ years ago) my maxilla was pulled back to compensate for my small mandible, so both jaws are recessed now. 

The suggestion of my orthodontist and surgeon is the following: 
- Step 1) Pull 4 teeth: upper 2 wisdom teeth and lower 2 pre-molars. This is scheduled tomorrow afternoon; 
- Step 2) Bring back the bottom teeth that are now inclined too much forward and thus ‘recreate’ the overbite through orthodontics (braces will be placed in 6 weeks);
- Step 3) Have the bimax surgery and bring forward the mandible more than the maxilla (hence surgically correcting the recreated overbite).
- PS: CCW rotation is not yet decided upon.
- PPS: Neither is genioplasty, but the 3D virtual treatment planning would make this more clear.
- PPPS: In any case, I was planning to get rhinoplasty surgery after jaw surgery, to get rid of the hump and straighten my deviated septum. I have seen another surgeon for this, who advised me to get the jaw surgery first and advised not to let the jaw surgeon touch the nose too much, because often this means in less cartilage which he needs for the rhinoplasty.

I have listed for myself the things I ideally would want from this surgery aesthetically speaking and the things I definitely want to avoid. I suppose this will make communication with my surgeon easier during the work-up. 

WANTS (Look at my own morphs) 
1. I want to have a jawline and + a more forward chin (so the double chin is gone and my nose is more in proportion)
2. I want my facial thirds to still be in proportion (I feel like they are today)
3. I don’t really have a severe gummy smile, but when I smile very wide you do see the gums. So I might benefit from a little less gum/teeth show (maxilla impactation) 
4. Ideally, I’d like a bit more upper lip. I feel like it’s ‘curled’ inside now, because of the lack of teeth support

DO NOT WANTS
1. I don’t want a sharper gonial angle. If I look at my CBCT scan, I think it’s good as is. A sharper angle will make my face look too boxy (like this)...
2. I don’t want a chin that is too short or too long. In frontal view, I kind of like the current length of my chin as it seems in proportion
3. I want to avoid thinner (upper or lower) lips. Too often I see this post jaw surgery
4. I don’t want my philtrum to look longer post-op. This too I see too often
5. I don’t want my nose to get wider. If, despite counter measurements, my nose still got any wider I might ask my rhinoplasty surgeon to include alarplasty (alar base reduction)

What do you think of this approach? Is it a good idea? 
What do you think of my morphs and wishes? Is this achievable? 
How do you feel about the following (given my aesthetic hopes): 
- CCW rotation? 
- Alar cinch? 

Thanks so much for all the support and information on this forum!

[GJ]

- CCW rotation?
- Alar cinch?

Yes, this is probably going to be your best option. The thing is, I'm not sure you'll get all your desires. You have 4 things you want and 5 things you don't want. My educated guess would be you'll get some things you want corrected, but other things you won't like. This is generally what happens.

Pulling teeth is almost always a bad idea.

[VincentGT]

All the surgeons and orthodontists I saw told me I need the pre-molar extractions to make room for the teeth that are now flaring out.

I asked my surgeon this as well and he told me he would never pull teeth if not necessary, but pulling them in order to make room for the advancement in jaw surgery is often necessary. If I want to keep all teeth they can do bimax, but I'd still be a skeletal class II.

[kavan]

OK, your scans, cephs and morphs certainly confirm you are candidate for maxfax (double jaw) surgery.

The suggestions of your ortho and surgeon are certainly in line with pre-surgery preparation in braces to 'decompensate' your bite (the bite you were given 15 years ago).

It's also true in most cases (and here in yours) that rhino should be done AFTER maxfax. One 'lucky' example of that is when there is hump on nose and/or the nose just looks too big on the face. Bringing forward the maxilla (Lefort aspect of surgery) advances the nasal base and gives a straighter nose bridge because when base of the nose is advance with the maxilla, the hump or conVEXity of upper nose bridge VISUALLY 'goes away' simple because its appearance is RELATIVE to the base of nose being too far behind.  Also, in the event, the nostril areas could be predicted (by the maxfax surgeon) to widen too much from the maxillary advancement, they can do something called an 'alar cinch' to mitigate the widening.In such a 'lucky' case, no rhino is needed after the maxfax surgery and it can resolve to a 'free rhino'. Why? Because the nose hump going away due to the maxilla advancement, in addition to the nostril widening being mitigated by the alar cinch has very good chance of fixing/improving aesthetic issues with nose so you don't need a rhino afterwards even though the maxfax technically is NOT performing a rhino. Your situation with the nose looks to veer in the direction of what I call a 'lucky' one. Also, maxillary advancement would tend to unfurl your upper lip which is also 'lucky' since you want that.

A word about morphs. Morphs don't predict the outcomes of a surgery. Although they visually communicate a desired result which can be in the venue of good aesthetics (which yours is), keep in mind you are using a morph program where you can make automatic changes in accordance to your aesthetic preference but you don't know what actual measure displacements you are doing (with the morph) as they relate to maxillary displacements (advancements and/or rotations), mandibular displacements and balancing that all with the BITE. So, a morph used to show a desired aesthetic outcome can't be used as PREDICTIVE software for the desired outcome. Hence, it can't be used as a DIRECTIVE to the surgeon to kick up the desired outcome you want to see in the mirror that your morph shows. You need to understand that.

The type of predictive software a maxfax surgeon can use is kind of complex. But it is something that allows them to displace the jaws in a variety of ways in addition to balancing the bite which is done first on the SKULL MODEL scan. Basically, the program conveys which combination of complex movements are allowable relative to a combined objective of balancing the aesthetics with the bite. That is to say, it can convey to the surgeon 'this or that' displacement can come with 'this or that' TRADE-OFF and let them keep on trying other combinations to optimize all. Software can also make somewhat of a prediction of soft tissue changes (the part you see to the FACE FLESH over the changed bone structure). However the program can't predict exactly the soft tissue changes. So, the surgeon can use the software to OPTIMIZE bite with AESTHETICS and take your morph into consideration when using the program to optimize all. But there can still be some deviations from the norm or desired aesthetic 'perfection'.

Anyway, a surgeon using a sophisticated program that is very close to PREDICTIVE SOFTWARE should be able to show you a visual CONTOUR CHANGE of the profile relative to your start point and that should give you some idea of how it compares to your morph.

The point I am making here (or at least trying to make) is that your chances of having a GREAT IMPROVEMENT are very HIGH. But it is not a thing where you can rule out; 'I don't want this and I don't want that' in any trade-off despite your morph showing exactly what you want to be achieved from the surgery. It doesn't work that way. Your trade-offs will probably be MINOR relative to the MAJOR IMPROVEMENT you stand to get from the surgery.

Feel free to cross reference everything I said here with your surgeon.

[VincentGT]

Hi kavan,

I was hoping you would answer.

Yes, you’re certainly right regarding desires and expectations. My surgeon told me the same thing. Still, I believe a morph of my own making and a list of concerns and ‘wishes’ might help with directing the final result without having unrealistic expectations.

Do you understand the choice for extracting the premolars and upper wisdom teeth? My surgeon is supposed to be one of the best of my country and was advised by the office of Dr Raffaini (as surgery in Italy wasn’t an option). The other surgeons I saw all advised the same extractions.

[kavan]

Hi kavan,

I was hoping you would answer.

Yes, you’re certainly right regarding desires and expectations. My surgeon told me the same thing. Still, I believe a morph of my own making and a list of concerns and ‘wishes’ might help with directing the final result without having unrealistic expectations.

Do you understand the choice for extracting the premolars and upper wisdom teeth? My surgeon is supposed to be one of the best of my country and was advised by the office of Dr Raffaini (as surgery in Italy wasn’t an option). The other surgeons I saw all advised the same extractions.

As to morphs, the correct morph protocol isn't a MOVING morph. Its the original on the left and the morph on the right. If it is moving, someone who could analyze the relative displacements would not be able to do so with a moving morph.

As to lower premolars, aside from it being common for them to be flared outward in prior ortho to make the 'bite right', they are usually at the wrong angle inclination for the jaw surgeon to make the JAWS right. To advance a recessive lower jaw, they need to push the lower teeth BACKWARDS and to do that, they pluck out the 1rst premolars because those are the ones first in line for GETTING IN THE WAY of pushing the teeth anterior to them backwards. So, in that regard removing them is a needed 'sacrifice' for BSSO advancement.

[VincentGT]

As to morphs, the correct morph protocol isn't a MOVING morph. Its the original on the left and the morph on the right. If it is moving, someone who could analyze the relative displacements would not be able to do so with a moving morph.

Something like this? Would you say (some) CCW rotation is applied in my morph? I just edited how I would like to end up looking, but I obviously lack the knowledge to know how to achieve this (or rather, approach this).

Would you, given my wishes, find it wise to ask my surgeon for an alar cinch?

As to lower premolars, aside from it being common for them to be flared outward in prior ortho to make the 'bite right', they are usually at the wrong angle inclination for the jaw surgeon to make the JAWS right. To advance a recessive lower jaw, they need to push the lower teeth BACKWARDS and to do that, they pluck out the 1rst premolars because those are the ones first in line for GETTING IN THE WAY of pushing the teeth anterior to them backwards. So, in that regard removing them is a needed 'sacrifice' for BSSO advancement.

Thank you so much for this. Too many people on social media seem to scream bloody murder whenever extractions are mentioned, but my surgeon told that would absolutely be the best idea in this case. Extracting the upper wisdom teeth is part of the same strategy then?

[kavan]

I can't see all IMGUR photos. I don't know why, IMGUR makes them disappear sometimes and sometimes not. So, i could not view them. Suffice to say, side by side original on left morph on right, lined up side by side. Analyzing displacements in a morph resolves to knowing the scale of the photo relative to 'real life' measure of something and using basic geometry skills using lines drawn through land marks and noting the differential. Anyway, I don't offer to analyze other people's morphs and resolve them back to types of rotations and approximations of advancements. It's a time consuming task.

As to alar cinch, it's usually not something the patient asks for the doctor to do. Instead the patient question to the doctor is 'Do you do an alar cinch if it looks like the maxillary advancement will widen my nostril area too much?

As to the people on social media being uber adverse to extractions, often that arises as a VESTIGE of extractions being used in orthodonture solely to make the 'bite right'. That is to say, the main associations with 'avoid extractions' arises from orthos doing that solely to make the bite right in a situation where it would have been better in the first place to make the JAWS balanced instead. Wisdom teeth are extracted if the surgeon determines they will be 'IN THE WAY' of a successful cut (like so you don't get what they call a 'bad break' due to wisdom teeth interfering with a clean cut.). Another reason is that jaw surgery takes about a year to heal/chill out and the surgeon might not want the risk of the wisdom teeth getting infected and needing to be extracted during the healing phase. They want them removed months before a surgery. How many is the surgeon's shot to call.

Something like this? Would you say (some) CCW rotation is applied in my morph? I just edited how I would like to end up looking, but I obviously lack the knowledge to know how to achieve this (or rather, approach this).

Would you, given my wishes, find it wise to ask my surgeon for an alar cinch?

Thank you so much for this. Too many people on social media seem to scream bloody murder whenever extractions are mentioned, but my surgeon told that would absolutely be the best idea in this case. Extracting the upper wisdom teeth is part of the same strategy then?

[kavan]

To my prior post, I shall add some additional information. I don't mean it to be an 'invitation' to totally analyze every thing. I'm offering it to help fill in some 'GAPS' of understanding that might still exist as to possible 'whys' of need for upper wisdom tooth removal and 'why' you think your chin is longer than it actually is when you look at it in FRONTAL perspective and like the (illusion) of length from frontal perspective.
-----------------

1: Why upper wisdom tooth removed?
Another possibility of upper wisdom tooth removal might be relative to:

a: your mandible will be displaced MORE than your maxilla
b: your lower wisdom tooth needs to be removed (because it is common in maxfax surgery for it to be removed to AVOID a 'BAD BREAK').

So, let's say your mandible will be ahead of your maxilla (even though your maxilla might be displaced 'forward') AND the distance it will be ahead is equal to or more than the WIDTH of one posterior mandibular molar. That would leave your upper wisdom tooth UNOPPOSED with reference to the bite.

When a tooth is not opposed by another tooth, there is no bite force acting on it to keep it in place. That makes a situation where it might want to MOVE. It could move down 'looking for its partner' or it could move in a wonky direction, one of which could be an OVERLAP with the 2cnd molar anterior to it, thereby CROWDING in on it, making harder to CLEAN the second molar and perhaps subjecting it to periodontal pathogens for that reason.

This is just my THEORY based on OBSERVATION and ANALYTICAL MIND. So, please cross reference my reasoning here with your doctor because it would be nice to know that I'm on target.

2: You like your chin in FRONTAL perspective but of course, you see the recession in profile.

The reason you like your chin in Frontal perspective is that you are actually looking at the EXCESS of the conVEXITY under your chin that is seen in PROFILE when you look at yourself in frontal perspective. So, the SLACK under the chin you see in profile is a conVEXITY. If one draws a horizontal line that is TANGENT to the MAXIMUM of this conVEXity, that line is going to be BELOW the anatomical point of the lowest point of the actual chin which is called the MENTUM. So, what you are actually looking at in frontal perspective and liking is NOT your actual chin length. The extra length you are looking at and liking is the PROJECTION of the conVEX profile SLACK under the chin. Although some background in art/drawing would make this intuitively obvious, the absence of that, that's how it goes.

The other concept at play with the chin is that it moves 'forward' during the BSSO and the forward movement is along the 'SLOPE' of the mandible which is an outward and down 'slope'. Everyone has a 'slope' to the mandible and that slope is outward and down (relative to looking at profile facing to the right), In maxfax, lingo, this is called the MANDIBULAR PLANE ANGLE. It's relative to the angle of inclination the mandible has with a HORIZONTAL plane. Some people have a HIGH 'slope'= 'high angle' people/patients. Others have LOW 'slope'= 'low angle' people/patients. You veer more towards 'low angle'. Anywway, with the displacement of the BSSO, the (most outward) chin point (pogonian) will be moving 'forward' which in terms of vector displacement is; OUTWARD (horizontally) and DOWNWARD (vertically); a combination of those separate vector displacements. Although your horizontal displacement vector is going to be more than the vertical displacement vector (because you veer in direction of low angle and/or are NOT high angle), the BSSO displacement from the maxfax surgery will pick up some to most of the CONVEX slack under your chin (so you don't see the excess length-of that convexity-- from frontal anymore) but since the chin point is going somewhat vertically down in the process of it going horizontally outward, it is highly likely that the VISUAL length you see to your chin in frontal perspective (presently) won't be changing much at all. Profile slack under the chin will be mitigated and the length you like looking at in frontal (at present) will be similar post BSSO due to the downward vector displacement from the BSSO.
-------

I can't see all IMGUR photos. I don't know why, IMGUR makes them disappear sometimes and sometimes not. So, i could not view them. Suffice to say, side by side original on left morph on right, lined up side by side. Analyzing displacements in a morph resolves to knowing the scale of the photo relative to 'real life' measure of something and using basic geometry skills using lines drawn through land marks and noting the differential. Anyway, I don't offer to analyze other people's morphs and resolve them back to types of rotations and approximations of advancements. It's a time consuming task.

As to alar cinch, it's usually not something the patient asks for the doctor to do. Instead the patient question to the doctor is 'Do you do an alar cinch if it looks like the maxillary advancement will widen my nostril area too much?

As to the people on social media being uber adverse to extractions, often that arises as a VESTIGE of extractions being used in orthodonture solely to make the 'bite right'. That is to say, the main associations with 'avoid extractions' arises from orthos doing that solely to make the bite right in a situation where it would have been better in the first place to make the JAWS balanced instead. Wisdom teeth are extracted if the surgeon determines they will be 'IN THE WAY' of a successful cut (like so you don't get what they call a 'bad break' due to wisdom teeth interfering with a clean cut.). Another reason is that jaw surgery takes about a year to heal/chill out and the surgeon might not want the risk of the wisdom teeth getting infected and needing to be extracted during the healing phase. They want them removed months before a surgery. How many is the surgeon's shot to call.

[VincentGT]

To my prior post, I shall add some additional information. I don't mean it to be an 'invitation' to totally analyze every thing. I'm offering it to help fill in some 'GAPS' of understanding that might still exist as to possible 'whys' of need for upper wisdom tooth removal and 'why' you think your chin is longer than it actually is when you look at it in FRONTAL perspective and like the (illusion) of length from frontal perspective.
-----------------

1: Why upper wisdom tooth removed?
Another possibility of upper wisdom tooth removal might be relative to:

a: your mandible will be displaced MORE than your maxilla
b: your lower wisdom tooth needs to be removed (because it is common in maxfax surgery for it to be removed to AVOID a 'BAD BREAK').

So, let's say your mandible will be ahead of your maxilla (even though your maxilla might be displaced 'forward') AND the distance it will be ahead is equal to or more than the WIDTH of one posterior mandibular molar. That would leave your upper wisdom tooth UNOPPOSED with reference to the bite.

When a tooth is not opposed by another tooth, there is no bite force acting on it to keep it in place. That makes a situation where it might want to MOVE. It could move down 'looking for its partner' or it could move in a wonky direction, one of which could be an OVERLAP with the 2cnd molar anterior to it, thereby CROWDING in on it, making harder to CLEAN the second molar and perhaps subjecting it to periodontal pathogens for that reason.

This is just my THEORY based on OBSERVATION and ANALYTICAL MIND. So, please cross reference my reasoning here with your doctor because it would be nice to know that I'm on target.

I asked him about the premolar extractions. He told me there is not enough place in my mouth to bring back the frontal teeth (which are leaning forward too much), so I needed those extractions. In theory I could have had just more CCW rotation, but that would not fix the forward leaning frontal teeth. These are prone to more gum recession and earlier loss if left with that much flaring outwards. Also, he told me my lower lip position is not ideal because those teeth are pushing it a bit outwards. With the extractions and braces they can bring back these teeth and advance the mandible more, which would be ideal.

I did not ask about the upper wisdom teeth extractions, but I always understood from my ortho this is the case because my mandible will be brought forward MORE than my mandible and so the upper wisdom teeth would not have 'matching' lower teeth.

I also asked about lower wisdom teeth loss during surgery, but my surgeon said he's never had this in his whole career and he's confident I wouldn't lose more teeth.

2: You like your chin in FRONTAL perspective but of course, you see the recession in profile.

The reason you like your chin in Frontal perspective is that you are actually looking at the EXCESS of the conVEXITY under your chin that is seen in PROFILE when you look at yourself in frontal perspective. So, the SLACK under the chin you see in profile is a conVEXITY. If one draws a horizontal line that is TANGENT to the MAXIMUM of this conVEXity, that line is going to be BELOW the anatomical point of the lowest point of the actual chin which is called the MENTUM. So, what you are actually looking at in frontal perspective and liking is NOT your actual chin length. The extra length you are looking at and liking is the PROJECTION of the conVEX profile SLACK under the chin. Although some background in art/drawing would make this intuitively obvious, the absence of that, that's how it goes.

The other concept at play with the chin is that it moves 'forward' during the BSSO and the forward movement is along the 'SLOPE' of the mandible which is an outward and down 'slope'. Everyone has a 'slope' to the mandible and that slope is outward and down (relative to looking at profile facing to the right), In maxfax, lingo, this is called the MANDIBULAR PLANE ANGLE. It's relative to the angle of inclination the mandible has with a HORIZONTAL plane. Some people have a HIGH 'slope'= 'high angle' people/patients. Others have LOW 'slope'= 'low angle' people/patients. You veer more towards 'low angle'. Anywway, with the displacement of the BSSO, the (most outward) chin point (pogonian) will be moving 'forward' which in terms of vector displacement is; OUTWARD (horizontally) and DOWNWARD (vertically); a combination of those separate vector displacements. Although your horizontal displacement vector is going to be more than the vertical displacement vector (because you veer in direction of low angle and/or are NOT high angle), the BSSO displacement from the maxfax surgery will pick up some to most of the CONVEX slack under your chin (so you don't see the excess length-of that convexity-- from frontal anymore) but since the chin point is going somewhat vertically down in the process of it going horizontally outward, it is highly likely that the VISUAL length you see to your chin in frontal perspective (presently) won't be changing much at all. Profile slack under the chin will be mitigated and the length you like looking at in frontal (at present) will be similar post BSSO due to the downward vector displacement from the BSSO.
-------

Thanks for this very clear explanation. Would this mean I'm one of the rare cases where I only need advancement in both jaws, without any CCW rotation? I do fear a lengthier philtrum in that case...

Would you say, based on my pictures, that I have rather a long face or short face? I always thought my facial thirds were (frontal) kind of in balance.
And does CCW rotation always mean your face (or chin) gets shorter?

Oh and if I can avoid a genioplasty, I would.

[kavan]

I asked him about the premolar extractions. He told me there is not enough place in my mouth to bring back the frontal teeth (which are leaning forward too much), so I needed those extractions. In theory I could have had just more CCW rotation, but that would not fix the forward leaning frontal teeth. These are prone to more gum recession and earlier loss if left with that much flaring outwards. Also, he told me my lower lip position is not ideal because those teeth are pushing it a bit outwards. With the extractions and braces they can bring back these teeth and advance the mandible more, which would be ideal.

I did not ask about the upper wisdom teeth extractions, but I always understood from my ortho this is the case because my mandible will be brought forward MORE than my mandible and so the upper wisdom teeth would not have 'matching' lower teeth.

I also asked about lower wisdom teeth loss during surgery, but my surgeon said he's never had this in his whole career and he's confident I wouldn't lose more teeth.

Thanks for this very clear explanation. Would this mean I'm one of the rare cases where I only need advancement in both jaws, without any CCW rotation? I do fear a lengthier philtrum in that case...

Would you say, based on my pictures, that I have rather a long face or short face? I always thought my facial thirds were (frontal) kind of in balance.
And does CCW rotation always mean your face (or chin) gets shorter?

Oh and if I can avoid a genioplasty, I would.

I told you the similar about the pre-molar extractions to the lower jaw. They need to be removed to make room for the BSSO advancement and also that lower mandibular teeth flaring too much forward is an unfavorable angle for them to be in. So, ya, since the inclination of the lower teeth have a bearing on the inclination of the lower lip, your sugeon told you right.

I told you similar to what your ortho said about the upper wisdom teeth to the MAXILLA; It would have no opposing tooth. I told you that (in GENERAL), they like to remove the wisdom tooth to the MANDIBLE to avoid a bad break. So, if your surgeon told you something SPECIFIC to your particular case such that you didn't need your lower wisdom tooth removed, well we can say there are GENERAL reasons surgeons like to remove the lower wisdom tooth and reasons highly SPECIFIC to a particular person's case where they don't need to be removed.
-----
I told you that your upper lip would tend to be UN-FURLED with maxillary advancement. You stated you did not like the 'curl' to your upper lip. So the term 'unfurled' can be taken as uncurled as in straightened out somewhat or having less of a CURVE to it. Upper lip area= PHILTRUM + the upper LIP.

Maxillary advancement will tend to straighten out the upper lip area, make LESS the curl or the furl-up it has to that area which includes the philtrum. OK.
Your request to have your upper lip (area) uncurled because you don't like that in profile perspective but also don't want the philtrum to look longer is a self negating request. Although your upper lip area which includes the philtrum will not be made physically longer, the more of a conCAVE curve one sees in profile is made straighter, the more it will look longer in frontal perspective. So, nothing can be done about that very fundamental principle when the specifics of what you want vs. what you don't want are self negating.

I would say you have a short face and I already told you the principle of looking at a conVEX area in profile (under chin) and it projecting (visibly) longer in frontal and you liking the extra 'length' of your chin in FRONTAL was due to the convex curve under chin giving the illusion of a longer chin when viewed in frontal.
The conCAVE CURVE to your upper lip area you don't like in profile when made less via maxillary advancement, when straightened out, could make your philtral area look longer to you. The fundamental principles of curves seen in profile projecting differently in frontal when straightened out can't be changed in accordance to not liking how something looks in profile but liking how it looks in frontal or not liking how it looks curled in profile , wanting it to be uncurled but not wanting it to look any longer in frontal. What someone wants to see or doesn't want to see on their face after maxfax surgery does not always conform to how things actually work.
---------------------------

CCW-r does not 'always' mean the face or chin will get shorter or look shorter. Although it can make the angle of inclination of both the maxilla and mandible less (because a decrease in the angle of inclination of the maxilla will have a proportional decrease in the angle of inclination of the mandible), the angle of inclination the mandible has with the horizont is still going to be a downward diagonal even though made less of one by the CCW-r done to the maxilla. So, a BSSO will still have it that the mandible will move in downward diagonal; vector displacement of horizontally outward and vertically downward. CCW-r can make the lower face shorter but a significant BSSO along with it still is displaced along a downward diagonal would tend to compensate for that.

Anyway, all this depends on the rotation of a triangle formed by 3 landmarks to the face: ANS, PNS and Pog and the extent of both the Maxillary advancement and the BSSO. So, I would defer you to your surgeon and his PREDICTIVE SOFTWARE given you seem to need to know in advance specifically, how your face is going to look to you if you do or don't get CCW.