Can somebody please help me figure out if I should get CCW rotation?

[DarrenG]

I'm considering bimax surgery for cosmetic reasons.

I went to the orthodontist today and was able to get a CBCT scan done. They let me take pictures of it.

Here's a link to a photo gallery with my CBCT scans and facial photos:
https://imgchest.com/p/ljyqdonne72

The first 2 photos are side view / front view from the CBCT scan. The last 2 photos are side view / front view of myself, taken with my phone camera.

The orthodontist noted that I have:

• "vertical maxillary deficiency"
  "midline deviation"
  "moderate" overcrowding of the upper teeth
  "severe" overcrowding of the lower teeth
  "overjet"

I've asked other people about this and they all tell me that I have "short face syndrome". Apparently, one of the dead giveaways of "short face syndrome" is that your upper teeth are not completely exposed when smiling. Whenever I smile, only the bottom half of my front teeth are visible, and my mouth takes on the shape of a trapezoid, instead of a crescent. Downgrafting would presumably push my maxilla downwards, which would expose my upper teeth, and change the shape of my smile.

Here is a link to 2 photos of my teeth when smiling:
https://imgchest.com/p/qe4graa9oyj


My chin is weak when viewed from the side, but when I'm "jutting", i.e., pushing my jaw forwards as far as possible, it massively improves my appearance.

Here's a link to 2 photos of myself from the side, demonstrating how jutting improves my side profile:
https://imgchest.com/p/n87wrarbqyx


I've learned so far that I would need to advance my mandible, as well as downgrafting the maxilla to improve my upper tooth show.

What I can't seem to find out is if I should try to get a linear advancement of both jaws, or CCW advancement.

My end goal is a face that is vertically lengthened and forward-grown in appearance, that looks natural and harmonious.

Thank you.

[kavan]

I'm considering bimax surgery for cosmetic reasons.

I went to the orthodontist today and was able to get a CBCT scan done. They let me take pictures of it.

Here's a link to a photo gallery with my CBCT scans and facial photos:
https://imgchest.com/p/ljyqdonne72

The first 2 photos are side view / front view from the CBCT scan. The last 2 photos are side view / front view of myself, taken with my phone camera.

The orthodontist noted that I have:

• "vertical maxillary deficiency"
  "midline deviation"
  "moderate" overcrowding of the upper teeth
  "severe" overcrowding of the lower teeth
  "overjet"

I've asked other people about this and they all tell me that I have "short face syndrome". Apparently, one of the dead giveaways of "short face syndrome" is that your upper teeth are not completely exposed when smiling. Whenever I smile, only the bottom half of my front teeth are visible, and my mouth takes on the shape of a trapezoid, instead of a crescent. Downgrafting would presumably push my maxilla downwards, which would expose my upper teeth, and change the shape of my smile.

Here is a link to 2 photos of my teeth when smiling:
https://imgchest.com/p/qe4graa9oyj


My chin is weak when viewed from the side, but when I'm "jutting", i.e., pushing my jaw forwards as far as possible, it massively improves my appearance.

Here's a link to 2 photos of myself from the side, demonstrating how jutting improves my side profile:
https://imgchest.com/p/n87wrarbqyx


I've learned so far that I would need to advance my mandible, as well as downgrafting the maxilla to improve my upper tooth show.

What I can't seem to find out is if I should try to get a linear advancement of both jaws, or CCW advancement.

My end goal is a face that is vertically lengthened and forward-grown in appearance, that looks natural and harmonious.

Thank you.

Part 1.

RE: 'Other people told me I had short face 'SYNDROME'.

Looks like these 'other people' don't distinguish between a syndrome and a cosmetic issue.

The key word here is 'COSMETIC' as in 'for COSMETIC reasons'.
The key word here is NOT 'SYNDROME' as in 'short face syndrome'.

In terms of linear distance relationships where (horizontal) lines are drawn through some select landmarks of the face and the (vertical) distance between the parts is looked at (division of '1/3rds'), you have pretty much 'equal' divisions.

In terms of the frontal view, subjectively, you look pretty good and you also would/could/do pretty good to yourself when jutting out your jaw. So, on a spectrum of 'funny looking' to 'attractive', you veer on the attractive side. A SYDROMATIC person would veer more in the direction of 'funny looking' than 'attractive'.

In terms of both QUANTITATIVE (objective) distance relationships and also QUALITATIVE (subjective) impressions, you are NOT 'sydromatic'. Having a cosmetic issue that could be improved on (via maxfax surgery) does NOT mean the issue is within the spectrum of 'syndromatic'.

The ortho's assessment as to the deficiency, deviations and issues with the teeth as it relates to the smile is correct. But that does NOT confirm what WTF these 'other people' assess to the spectrum of 'syndromatic'.

So, I want to get THAT part out of out of your head before I give my take.
--------------------------------------------
Part 2:

RE: '...should I try to get a linear advancement of both jaws, or CCW advancement.'

I can't answer the question as you ask it. Because, although you SAY you 'understand' you need a MAXILLARY DOWNGRAFT, if you really understood you needed a maxillary downgraft, linear advancement would not be one of the choices to ask about BECAUSE linear advancement doesn't include any downgrafts. It just advances both jaws pretty much equally.

What I CAN say here is that you would benefit from a MAXILLARY DOWNGRAFT, in particular, the type that downgrafts the OVERALL maxilla which pushes the whole thing down in which there is MORE upper tooth show (the entire upper arch) and a longer lower '1/3rd' of the face so the lower jaw area and the chin cast longer on the face. Hence, although you don't have 'short face SYNDROME', cosmetically, you would look better with a longer lower 1/3rd.

An OVERALL maxillary downgraft elongates the ENTIRE maxilla and increases the vertical length of the face whether or not it has 0 rotation or 'net' CCW or CW. For example a 0 rotation overall maxilla downgraft elongates the entire lower '1/3rd' of the face and so do overall maxillary downgrafts with either net CCW or net CW. They ALL address the goal of more vertical length.

A 0 rotation overall downgraft would elongate down equally. One with 'net' CCW rotation would benefit someone needing more 'uptilt' to the chin area and one with net CW rotation would benefit someone needing more 'down tilt' to the chin. Although all will vertically elongate the lower face/ chin area by pushing the area down from above, the choice of net rotation would depend on whether or not the person would benefit more from more of an uptilt to the chin or a down tilt. It would also depend on whether or not the person needed a an uptilt or down tilt to the upper front teeth. Since, your chin already is in an uptilt position and your front upper teeth have an OVERJET, double jaw advancement over a  a net CCW-r could exaggerate that. An overall max-downgraft with net CW would give the chin more a a down tilt and also decrease the overjet. It would address/correct the ORIENTATION of both the maxilla and mandible and also your goal of more lower face elongation.

The entirety of the surgery would include advancement of both jaws in addition to DROPPING THEM DOWN FROM ABOVE (overall maxillary downgraft) AND correcting the bite/teeth. So, I do think net CW-r would work better for you because both the teeth AND the chin get a down tilt with the net CW- overall maxillary down graft. That is to say, advancement of both jaws would look better on you if the overall maxillary downgraft was a net-CW.

Also, your photo of 'jutting out your jaw' looks more like a morph than a jut. Either way, neither a morph nor a jaw jut predict surgery outcomes. But it does convey you would look better with both vertical elongation of the lower '1/3rd' of the face in addition to lower jaw advancement. Since your chin is tipped up in the before and tipped down in the after, that jives with what I said: 'overall maxillary downgraft with net CW-r'.

Hence your question of: '..should I try to get a linear advancement of both jaws, or CCW advancement.' can't answered as you ask because the solution involves NEITHER CCW-r nor linear advancement. It involves an overall  maxillary down graft (that spans the entire maxilla) and one with net CW-r.

[DarrenG]

"It involves an overall maxillary down graft (that spans the entire maxilla) and one with net CW-r."

Would this mean a high-cut LeFort 1, or a LeFort 2?

Also, are there any surgeons in particular that you would recommend for short face syndrome?

[kavan]

"It involves an overall maxillary down graft (that spans the entire maxilla) and one with net CW-r."

Would this mean a high-cut LeFort 1, or a LeFort 2?

Also, are there any surgeons in particular that you would recommend for short face syndrome?

Sorry dude but your questions reveal you're unable to understand (my) explanations. I put a lot of time and effort into my prior explanations and they went NOWHERE.

1: NEITHER through a high-cut Lefort 1 NOR a Lefort 2.

It should be IMPLICIT what type of Lefort cut is being referred to without asking this question. The fact that it isn't reveals your lack of basic understanding runs too deep for me to fill in.

2: WTF?? I tell you are NOT sydromatic and you ask which doctors treat the SYDROME. The question reveals you couldn't cognitively 'digest' information that differentiated a SYDROME from a COSMETIC issue.

Sorry dude, but when I find that my explanations don't result in actually communicating any information but instead elicit the wrong questions, we need to resolve to COMMUNICATION between us is NOT working out. So, I'm going to leave you to the 'other people' who ever they may be. I'm out of here.

[DarrenG]

1). I actually understood quite a bit of your explanation, about 90% of it at least. My question regarding the LeFort was simply about where they would make the cut.

2). I apologize for using the term "syndrome", when it wasn't applicable. I understand that it's a cosmetic and not a medical issue, my use of the term "syndrome" was just out of habit. I suppose I could just refer to it as "short face appearance", or whatever makes you happy.

I'm not the type of person to get hung up over errors in terminology, as long as it's understood what's being communicated.

[kavan]

1). I actually understood quite a bit of your explanation, about 90% of it at least. My question regarding the LeFort was simply about where they would make the cut.

2). I apologize for using the term "syndrome", when it wasn't applicable. I understand that it's a cosmetic and not a medical issue, my use of the term "syndrome" was just out of habit. I suppose I could just refer to it as "short face appearance", or whatever makes you happy.

I'm not the type of person to get hung up over errors in terminology, as long as it's understood what's being communicated.

It should be IMPLICIT the Lefort 1 cut is the reference. Asking if it was either of 2 different cuts demonstrated it wasn't.

 I wasn't affronted by your use of 'sydrome' but by continuing to use it after I spent time elaborating on the differences of syndrome and cosmetic demonstrated no understanding on your part of my prior explanation.

[DarrenG]

I actually understood your distinction between a syndrome and a mere cosmetic issue, I was just sloppy in my terminology in my response. Apologies.

Are there any surgeons that you'd recommend for someone with my aesthetic concerns?

[kavan]

I actually understood your distinction between a syndrome and a mere cosmetic issue, I was just sloppy in my terminology in my response. Apologies.

Are there any surgeons that you'd recommend for someone with my aesthetic concerns?

No reason for me to answer yet another question where you claim you 'understand' something but again with NO demonstration that you actually learned anything from the information given to you.It's right there in front of you. The  ORTHO told you that you have vertical maxillary deficiency and a maxillary downgraft is needed for that. So, you ALREADY have someone to ask for referrals/suggestions.