looks like you might have a prominent anterior nasal spine which is when the top part of the upper lip area is kind of tethered to the colemella. It is something that could look worse if the maxilla area is advanced. It is addressed via a rhinoplasty to reduce the ANS. Advancement of the maxilla works for more nose support WHEN the ANS needs to be advanced. So, that would work against you if you had the maxilla advanced because the ANS is advanced in maxillary advancement. You should avoid assuming that moving PIXELS on a morph is a prediction of the result.
Hi kavan, thanks for your response.
I don't actually know whether I have a prominent anterior nasal spine. No surgeon ever mentioned this. They did however mention the fact that my maxilla is somewhat recessed, even the surgeon who made the simulation from this post. So, even if the ANS is prominent and I would need a seperate rhinoplasty to remedy this, I would still like the advancement of the maxilla because of the concave look my middle facial third now has.
Also, in response to another post of mine last year, you said the following:
OK, your scans, cephs and morphs certainly confirm you are candidate for maxfax (double jaw) surgery.
(...)
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.
(...)
If you see
this unedited picture - where I jutted my mandible forward - I believe it to be quite obvious that I have a flat and recessed maxilla. Again, all surgeons mentioned this. It also would be the conclusion of
this scan and the conclusion of my CBCT Dental, which sounded like this:
"Examination: CBCT DENTAL
Cone Beam CT of the paranasal sinuses
Examination without contrast with axial slices.
No sinusitis.
Cone Beam CT of the maxillofacial complex
The occlusion at the molar level appears normal.
SNA = 79 degrees
SNB = 75.3 degrees
ANB = 3.7 degrees"If I'm not wrong these degrees would point out that the maxilla is somewhat recessed and the mandible is more severely recessed.
The main thing I'm struggling with is the reasoning why my surgeon discouraged me to go for the maxilla advancement: if the maxilla is advanced, the mandible should be advanced even more. He warned for flaring gonial angles. I'm hoping to get a second opinion about this, even more so if we would only advance the maxilla, let's say 3 or 4 mm. Will this 3 or 4 extra mm of (corresponding) mandible movement really create flaring gonial angles? That's what I would like to figure out. And whether there is a way to compensate for this, e.g. bone shaving, etc.
Thanks in advance for your, much appreciated, insights.
