Poor Facial Development | Dr. Walline | Advice

[ForeignCartographer]

Hi All,

I would like some advice on what my best course of action is.

A bit of background: I had camouflage orthodontics when I was 14-15, leaving me with recessed jaws (in fact my entire head seems to be recessed). Since the age of 18 I have suffered from bruxism, TMJ issues and neck pain. I have always had poor, forward head posture.

I have already had EASE with Dr Kasey Li, which has improved my nasal breathing, and I am due to have MMA with Dr Walline (LACOMS) next year.

Since these scans were taken, I have had:

- 3 wisdom teeth removed, leaving upper left remaining because UL4 was extracted when I was younger.
- Burried LL3 removed.

I will attach my report from Dr Walline and some photographs, in various angles and postures, for your perusal. 

I am sure Dr Walline's plan will be adequate but I would also like some advice from the community here. I am slightly worried that Dr Walline's morph was taken with my regular, poor, forward head posture. When I go for the pre-op, should I get him to take it with a more upright posture (ie my goal posture)?

Many thanks in advance.

Photos: https://imgur.com/a/dxmHf0v
LACOMS Report: https://imgur.com/a/we4syPE

PS Please ignore the swollen eye in the LACOMS photographs, it was temporary.

[kavan]

I'm not going to get into head posture here. So, ask the doctor when you get there if it made much of a difference.

IMGUR actually blocks out (at least to me, maybe because I'm not a member) your plan.

From what I can see from your profile pic (first one on the IMGUR photo link), it looks like you're a candidate for a significant lower jaw and chin advancement. Maxillary advancement looks minor. Lefort 1 (cut to the maxilla) to rotate CCW-r which helps maximize the lower jaw advancement and minimize over advancement of the maxilla, most likely is what your plan conveys albeit in quantitative terms of displacement measures.

Just so you know in advance, I don't calculate exact mm measures for anyone.

The doctor named is associated with being a good one to go to and to the best of my knowledge is adept with the CCW-r. So, I wouldn't think to second guess his plan.

[GJ]

It looks like his plan is a conservative CCW rotation, which I think is appropriate here. I wouldn't worry about head posture too much. You can bring it up and just ask if they compensate for that, but that's a good facility, and I'm sure they know about frankfurt vs all the other methods and will get the head posture right. It is nerve wracking when assistants instead of the doctors are taking these records. Personally I think the surgeons should take records/scans to avoid even the possibility of an issue.

[ForeignCartographer]

Thank you both for your advice, I appreciate it!

[TWGOAT]

Thank you both for your advice, I appreciate it!

What you consider your good posture on your picture is a chin tuck, head may be more back over the shoulders that way but its tilted down.

The LACOMS photos seem in natural head position (looking straight forward) but anyway when they plan they put your head in optimal position.

Plan looks good.

Head posture should improve with advancement and be more in line with shoulders