Comparison of two bimax simulations

[VincentGT]

So here I am again.

Attached you find the pictures of my face.

A few months ago I cancelled a surgery because my surgeon would only do a BSSO and not bimax, although it was always explaind as a bimax. His reasoning: bimax would mean the mandible needs to be advanced (even) more and this would result in flaring mandible corners, which you don't want. The original simulation you find here.

A few weeks after the cancelled appointment, he agreed to make a simulation of bimax ("just to show how little of a difference there is"). So I'm not even sure he would be willing to perform this plan. This bimax simulation you find here.

And although compared like that the difference doesn't seem that great, it actually is if you draw a straight line, like so.

In the meantime I've seen another surgeon who simulated bimax. He understood my wished for a slightly advanced maxilla. You find his simulation right here.

What do we think of these simulations? Any suggestions or opinions?
I think the last one contains some CCW, which would probably be benefifical. But although I have more than enough teeth show, I don't really have a gummy smile today. So I hope this CCW wouldn't change my teeth show drastically.
I don't think I necessarily need genio as there is quite a bit of chin bone. It's always possible afterwards too.

[GJ]

Tough call. You appear to have a large enough overjet where I'd only do the lower jaw. Moving the upper jaw is where all the problems happen (nose, chimp look, too long/short, etc)...you're in a grey zone. I'd do lower jaw and maybe a small genio.

[VincentGT]

The thing is: my upper jaw IS a few mm recessed; every surgeon confirmed this. It’s hard to pass on it then. Here you see a picture of my facewhere I jut my lower jaw forward. I think the maxilla recession is obvious this way. On the right side you a morph with upper jaw advancement.. way better I think.

[GJ]

To me that's a lot of risk for that slight improvement (if it even is one). The left looks good, and you won't have a wider nose or other risks that come with moving the upper jaw, which will more than offset any gain in the profile. Also, jutting the jaw forward isn't how the surgery will actually look. Most of the problems of jaw surgery come from moving the upper jaw.

If you think the risk it worth it then do it, though.

[kavan]

I think you would be OK with the double jaw surgery. Although the upper jaw looks RELATIVELY more advanced than the lower jaw, the upper jaw might not be 'over advanced' in its own right. A bit more advancement would tend to give more support to the base of the nose and give a straighter nose (dorsal) profile and with less downward tip rotation. Also, to get a good advancement to the lower jaw via CCW, they have to cut into the maxilla to affect a rotation. So, it's not as if cutting into the maxilla to provide a CCW-r and with a small amount of advancement is going to risk a bad base of the nose. I mean, a lower jaw advancement can be effected with just the CCW-r and no maxilla advancement. But again, to get a good lower jaw advancement via CCW-r, one does need a Lefort 1 cut to the maxilla to initiate the rotation even if there is no maxillary advancement. From those photos (front), I don't think the prospect of the gonial angles flaring out is going to be any aesthetic detriment either given that you have wide prominent cheek bones.

Basically, I don't see this as an AESTHETIC 'risk' for you to get the double jaw surgery. Looks more to me in the venue of an aesthetic 'pay-off' if you get a little upper jaw advancement and of course the CCW-r for which the maxilla needs to be cut into whether or not you get any advancement. No aesthetic risk either for getting more outward flare to gonial angles. Might even be possible to get a good advancement of the chin point with the BSSO because it can be taken out further with the CCW-r, in which case, you might not need a chin cut for a genio.

Feel free to cross reference what I told you here with the doctor/s who WANT to provide the double jaw surgery given you don't want the guy who just wants to do ONLY the lower jaw.