Opinions on my plan

[Dex1816]

That's a huge movement and probably not justified bases on the scan you posted. The ANS can be trimmed to help with protrusion, to some extent.

Thanks for your comments. What would you say was justified based on the scan?

[Dex1816]

I think a large piece of the puzzle in all of this is a presumed likelihood of me developing sleep apnea when I get older. I originally perused jaw surgery for aesthetic concerns, and it was only later that I learned people with my sort of profile usually have very small airways and so are at risk for sleep apnea. From what I have been told, it is an inevitability that I will have issues when I get older due to soft tissue laxity, and so that has been a large reason for the size of the advancements in my plan.

The balance between a sleep apnea focussed plan and an aesthetic one seems to be causing something of a discordance between my surgeon and I. As I understand it, those treated for severe sleep apnea theoretically require to be advanced as much as possible as is within the boundaries of safe advancements, and this doesn’t necessarily correspond to the most ideal aesthetic outcome.

Having questioned the aesthetic risk of over-advancement and asked about the plan being dialled back somewhat, my surgeon agreed to do so but reiterated that in his professional opinion, this would not be congruent with adequate treatment to best open up my airway — that this would be a trade off I would have to accept.

Given that I don’t currently have any sleep problems and as I say, am here in the first instance to fix some deep insecurities about my face, it’s difficult for me to assess all of this from a standpoint of clarity. I’m sure the proposed plan would open up my airways more than a more conservative one, but is it really necessary? At the same time, I see this study referenced a lot: https://pubmed.ncbi.nlm.nih.gov/12377834/
Having assessed a huge amount of data, they found airway narrowing was almost always at its worst at the base of the tongue, and even for sleep apnea cases, every case I see seems to be moved 7mm as a maximum in the upper jaw.

As has already been discussed at length, however, all I have is the displacement models above as my best guide, and this is always going to be a leap of faith. I also recognise I have no where near enough knowledge on the topic to be assessing the situation myself, but of course it’s also the case that no surgeon is infallible, either.

[kavan]

You cite Arnett's analysis within this string along with a diagram of 'FAB' and AS IF you understand it to claim or otherwise imply your surgeon is using a DISSIMILAR method; one that does NOT utilize Arnett's TVL and most of your concerns stem from that claim. It turns out you failed to  draw a straight vertical passing through the Sn point where Arnett's TVL is found on your surgeon's proposal.

His analysis called 'FAB' (Face, AIRWAY and bite) optimizes those 3 things, usually via CCW along with MMA. So, if you wanted to know if your surgeon was using the Arnett analysis with it's associated TVL in planning, the fact that he was using CCW along with MMA should have been a clue. Another clue would be to look at where Arnett passes a TVL (through the Sn point) and pass one on your surgeon's proposal. But AFTER citing Arnett's TVL and having access to a diagram that showed where it is drawn and where the soft tissue profile is RELATIVE to it, you lacked the capacity to relate to it or apply the information correctly. Instead your 'concerns' revolved around nothing other than how DISCONNECTED you were and so disconnected that you failed to observe that your surgeons proposal was SIMILAR to Arnett's, if not SAME as Arnett's TVL. That is a very BAD conceptual disconnect to have.
 
Included is a screen shot of your surgeon's proposal with Arnett's TVL drawn on it along with your 'concerns' that your surgeon is NOT using same or similar FAB optimization. It shows that the concerns you express about your surgeon using dissimilar optimization aesthetic guidelines are baseless. Clear as day, he used same/similar as does Arnett. The concern here is your inability to see he is.

Also, keep in mind that the risk of your surgeon 'over advancing' you with his decision OR the risk of his under advancing you with your 'guidance' at the helm of the decision is reduced to 0 if you have NO SURGERY.
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