What kind of surgery was used here

[Freddie54]

I came across this result from a retired french surgeon on youtube and was blown away from the result does anyone knows what kind of surgical procedure was operated on the women here ?


Looks like Clockwise rotation to me but I’m not sure, here’s the video if you wanna check there’s subtitles the patient case is around 13:00 https://youtu.be/JlR_-sOcZPM?si=Nr1VyTfnN5P9orL2

[kavan]

Her lower 1/3 of her face is longer in the after, she starts with little upper tooth show and maxillary recession. So, most likely an overall graft to the maxilla with net CW-r in addition to maxillary and mandible advancement.

[Freddie54]

Her lower 1/3 of her face is longer in the after, she starts with little upper tooth show and maxillary recession. So, most likely an overall graft to the maxilla with net CW-r in addition to maxillary and mandible advancement.

Where the graft was used ? Isn't graft used only in CCW ? Why would a CW need a graft ? Also do you think the same method could be used on someone with relative normal upper teeth show ?

[kavan]

Where the graft was used ? Isn't graft used only in CCW ? Why would a CW need a graft ? Also do you think the same method could be used on someone with relative normal upper teeth show ?

My prior statement conveyed where an OVERALL maxillary graft would be used which means spanning the entire maxilla with purpose of vertically elongating the entire maxilla. That is HOW the lower 1/3rd of face gets LONGER and gets more upper tooth show on a person with a vertically short maxilla who has little to no upper tooth show.

NO. Grafts are not 'only used' in CCW. If that were the case, then 'only' people needing a CCW graft could get a graft and people needing a CW graft couldn't get any. Your question of: 'Why would a CW need a graft ?' assumes that 'only' people needing a CCW graft are candidates for any grafts and you ask after I explained the type of graft the person had. Let me put it this way: If the person in the photo who started with lack of upper tooth show and short lower 1/3rd ended up with a longer lower 1/3rd and more tooth show didn't have the the graft I told you she had, she wouldn't have had the improvement seen in the after.

Different types of grafts for different needs:

ISOLATED:
a: Posterior downgraft ISOLATED to posterior maxilla = CCW posterior downgraft
b: Anterior downgraft ISOLATED to anterior maxilla= CW anterior downgraft.

OVERALL DOWNGRAFTS:

Overall downgrafts span the entire maxilla to elongate the maxilla.
Candidates= people who have a short lower 1/3rd because of a short maxilla and also who have LACK up upper tooth show.

Rotation of Overall downgrafts:

If the anterior part of downgraft is longer than the posterior part, the NET rotation is NET CW

If the posterior part of the downgraft is longer than the anterior part, the NET rotation is NET CCW.

If the downgraft to the overall maxilla is uniform throughout, then there is no NET rotation.

QUIZ for you:

1: Are grafts 'only' uses in CCW? Yes____. No___

2: What type of graft did the person in the photo (who ended up with a longer lower 1/3rd and more tooth show) most likely get?

a: an isolated CW anterior downgraft
b: an isolated CCW posterior downgraft
c: an overall downgraft to elongate maxilla with NET CW-r
d: an overall downgraft to elongate maxilla with a NET CCW-r

3: As to the question of: CAN the 'same method could be used on someone with relative normal upper teeth show ? Let's see if you can answer that yourself now that I gave you the basic relationships.

Would an overall downgraft to elongate the lower 1/3rd (whether or not it's net CW or net CCW rotation) that INCREASES upper tooth show be a method to use in a person who had normal upper teeth show and didn't need any extra upper teeth show?  Yes____. No____.

[tie]

Hi Kavan, long time.
Its took me a bit so see the change its seems so subtle but yes makes a different and, and i hate to upgrade people but upgraded her. But seemsso subtle. 
Just wonder , more philosophiclly - do you feel auch surgeries are needed  does doctors do them ? I looked at the cases before in this video all girls looked beautiful even as thwg werd "before" .

And dont get me wrong, im a guy to see subtle changes.  Didnt knlw doctor do surgeries in such cases.

Her lower 1/3 of her face is longer in the after, she starts with little upper tooth show and maxillary recession. So, most likely an overall graft to the maxilla with net CW-r in addition to maxillary and mandible advancement.

Her face also looks more lifted and i get it why. I winder if she could get rhis cheek bone lifted and skin stretched look with plastic surgery instead (just wondering, alsso for myself)

[kavan]

You would have to refer to the video if you wanted to find out which doctor did the surgery. In general, the point I was making is that clockwise rotation GRAFTS are possible and were most likely used in this particular case.

[Freddie54]

You would have to refer to the video if you wanted to find out which doctor did the surgery. In general, the point I was making is that clockwise rotation GRAFTS are possible and were most likely used in this particular case.

Sorry to annoy but I stumped on this case from Raffaini and it seems the guy’s face got longer while getting CCW this time ? How is that even possible isn’t CCW logically always makes the face shorter or at least should NOT make it longer.

[kavan]

Sorry to annoy but I stumped on this case from Raffaini and it seems the guy’s face got longer while getting CCW this time ? How is that even possible isn’t CCW logically always makes the face shorter or at least should NOT make it longer.

You're asking a question I won't address in the absence of demonstrating that you even learned anything from the LOGICAL information I broke down which was followed by a very simple QUIZ to see IF you learned anything from it.

ETA: Basically, IF you had learned anything from my reply in #3 of this thread, you would have been able to answer the quiz and it would logically follow that you would be able to answer for yourself why R's patient's face got longer with CCW-r. There were ample CLUES within the info I gave in reply #3 for you to 'figure out' WHY CCW- made the face longer.

[GJ]

Here we go again. "You're an idiot who I won't answer because you didn't go to Harvard or MIT"...does it ever get tiring sniffing your own farts, Kavan? One of the biggest narcissists I have ever come across, and the internet is a vast place. Yikes.

[kavan]

Here we go again. "You're an idiot who I won't answer because you didn't go to Harvard or MIT"...does it ever get tiring sniffing your own farts, Kavan? One of the biggest narcissists I have ever come across, and the internet is a vast place. Yikes.

I get it. Your 'here we go again' outburst here (and yet another time) is expression of your resentment for smart people in the capacity to TEACH. The irony here is that I broke down information to a very elementary level and you went ballistic (again) when I told the OP, I had given him enough information for him to answer his own question. NOTHING I explain on this board involves the member having an MIT or Harvard education to understand it, at most some background in elementary concepts in grammar school geometry and observations thereof are needed. Yet you claim being an MIT and HARVARD grad is needed?

I would NEVER insult anyone one for not going to MIT or HARVARD, especially MIT. No one is getting into MIT with an IQ LESS than 130 which is on the 'low' side relative to MIT. (Average IQ's are 100.) So NO expectation from me for ANY of your members to have what's going on as far as MIT goes. Although your outburst here was meant to insult me, looks like that was easier for you to do that than answer the OP's question of why was is R's patient had CCW-r but had the face also elongated.

The OP was given ample info to answer his subsequent question of WHY R's patient had CCW-r AND got length to the face. If that hit a NERVE with you to elicit your outburst, is this something where you're upset because you couldn't figure out either WHY the R patient he asked about had CCW and had extra length with that?
Basically, you had a CHOICE between answering his question for him and an outburst. You didn't choose to answer his question.

Ultimately, what I try to determine here is whether or not a person seeking information; asking questions about maxfax surgery can DIGEST information applicable to their questions. If they can't, there is nothing for me to build on to address any further questions they have and I don't answer any further questions from them, in which case, it's very CLEAR you're a better match for them and not me.

Damned straight. I prefer the members who demonstrate the capacity to learn something, especially so when it comes to concepts in maxfax that are ultimately related to geometrical relationships which are a BACKDROP for something having to do with points, angles, planes, lines, distance relationships and rotations. So, ya, I 'test' for the type of capacity I need in order to HELP someone LEARN MORE. If I see they lack what I need to HELP them learn more and enough so where they could answer their own questions, I have NO PROBLEM with resolving them to YOU. So, he's all YOURS from now on.

[Freddie54]

My prior statement conveyed where an OVERALL maxillary graft would be used which means spanning the entire maxilla with purpose of vertically elongating the entire maxilla. That is HOW the lower 1/3rd of face gets LONGER and gets more upper tooth show on a person with a vertically short maxilla who has little to no upper tooth show.

NO. Grafts are not 'only used' in CCW. If that were the case, then 'only' people needing a CCW graft could get a graft and people needing a CW graft couldn't get any. Your question of: 'Why would a CW need a graft ?' assumes that 'only' people needing a CCW graft are candidates for any grafts and you ask after I explained the type of graft the person had. Let me put it this way: If the person in the photo who started with lack of upper tooth show and short lower 1/3rd ended up with a longer lower 1/3rd and more tooth show didn't have the the graft I told you she had, she wouldn't have had the improvement seen in the after.

Different types of grafts for different needs:

ISOLATED:
a: Posterior downgraft ISOLATED to posterior maxilla = CCW posterior downgraft
b: Anterior downgraft ISOLATED to anterior maxilla= CW anterior downgraft.

OVERALL DOWNGRAFTS:

Overall downgrafts span the entire maxilla to elongate the maxilla.
Candidates= people who have a short lower 1/3rd because of a short maxilla and also who have LACK up upper tooth show.

Rotation of Overall downgrafts:

If the anterior part of downgraft is longer than the posterior part, the NET rotation is NET CW

If the posterior part of the downgraft is longer than the anterior part, the NET rotation is NET CCW.

If the downgraft to the overall maxilla is uniform throughout, then there is no NET rotation.

QUIZ for you:

1: Are grafts 'only' uses in CCW? Yes____. No___

2: What type of graft did the person in the photo (who ended up with a longer lower 1/3rd and more tooth show) most likely get?

a: an isolated CW anterior downgraft
b: an isolated CCW posterior downgraft
c: an overall downgraft to elongate maxilla with NET CW-r
d: an overall downgraft to elongate maxilla with a NET CCW-r

3: As to the question of: CAN the 'same method could be used on someone with relative normal upper teeth show ? Let's see if you can answer that yourself now that I gave you the basic relationships.

Would an overall downgraft to elongate the lower 1/3rd (whether or not it's net CW or net CCW rotation) that INCREASES upper tooth show be a method to use in a person who had normal upper teeth show and didn't need any extra upper teeth show?  Yes____. No____.

My bad, about the graft my question was stupid of course it’s totally appropriate to have a graft during a cw rotation or ccw my brain went out for a second.

So the answer was C she got an overall downgraft with CWr

Theoretically I guess it could be used on someone with normal tooth show but it will most likely look bad aesthetically whenever the person will smile they will basically get a gummy smile. So no.
 
My issue is that I have a short 1/3rd with visible nasolabial folds because of it but I have a relative “normal” tooth show, I honestly would not care or even mind getting a gummy smile if it was to correct my face as much as the patient in the picture I showed you. Im having a consultation with a surgeon tomorrow and I will ask him if it would be appropriate for me to get this kind of surgery.

[Freddie54]

Sorry to annoy but I stumped on this case from Raffaini and it seems the guy’s face got longer while getting CCW this time ? How is that even possible isn’t CCW logically always makes the face shorter or at least should NOT make it longer.

He got an Overall downgraft with net CCWr ?
In that case what would even be appropriate for me, I know it would definitely be an overall downgraft but would I need rotation and if so which one ? What exactly is the aesthetic difference between No rotation, CWr and CCWr with all of them using an overall downgraft ? Would the nose be more upturned for a CCW for exemple ? Thank you for your previous insights anyways.

[kavan]

My bad, about the graft my question was stupid of course it’s totally appropriate to have a graft during a cw rotation or ccw my brain went out for a second.

So the answer was C she got an overall downgraft with CWr

Theoretically I guess it could be used on someone with normal tooth show but it will most likely look bad aesthetically whenever the person will smile they will basically get a gummy smile. So no.
 
My issue is that I have a short 1/3rd with visible nasolabial folds because of it but I have a relative “normal” tooth show, I honestly would not care or even mind getting a gummy smile if it was to correct my face as much as the patient in the picture I showed you. Im having a consultation with a surgeon tomorrow and I will ask him if it would be appropriate for me to get this kind of surgery.

OK, you got the answer correct and I see my tutorial helped you think about the basic relationships as to rotations. But every patient has a different, if not unique, number of things going on that factor into the plan/proposal they will get (from a doctor). In this example or in any example where someone already got a type of surgery, the general 'answer' to what they got, along with my pointing out the varied relationships so the answer makes logical sense, just applies to a surgery outcome that's already been done, something in the PAST. It's not meant to be used as a future prediction for anyone else's specific situation or what to ask their surgeon for.

[kavan]

He got an Overall downgraft with net CCWr ?
In that case what would even be appropriate for me, I know it would definitely be an overall downgraft but would I need rotation and if so which one ? What exactly is the aesthetic difference between No rotation, CWr and CCWr with all of them using an overall downgraft ? Would the nose be more upturned for a CCW for exemple ? Thank you for your previous insights anyways.

Yes. Overall net CCW-r graft. That's what the person got in the photo where you see the outcome and the bone displacement model. But what a specific person already got in the past can't be used as a future prediction of what you should get. So, the answer to what this or that person had and why doesn't extend to what you should get and why.

[Freddie54]

Yes. Overall net CCW-r graft. That's what the person got in the photo where you see the outcome and the bone displacement model. But what a specific person already got in the past can't be used as a future prediction of what you should get. So, the answer to what this or that person had and why doesn't extend to what you should get and why.

I get what you’re saying but how would you know what is the best treatment for yourself then ? I know that I do have a short face and I want the best aesthetic outcome from front view how could I know what surgeons are going to give me the better result.