Thanks, Kavan.
I see what you are saying. The part marked in bold makes sense, but I'm not too sure that I draw the right conclusions from the given simulation.
In this simulation: I can tell that both jaws are advanced and given the slight rise of the mandible there should be some rotation, right? It's hard to tell though whether this is through an interior impaction or a posterior downgraft? The rotation seems modest, but this is likely desirable given that the degree of the gonial angles is already good and the fact that we are talking about only a slight maxilla movement (apparently 3mm). Teeth show doesn't need to change (much) so a modest move makes sense. I did get a few measurements of this simulation by the way: click here.
I think and hope that you are right that the impact of perceived philtrum length will be negligible because of the modest maxilla movement.
Do you think it's problematic that the upper and lower lip don't really line up in the profile view of the simulation? I know lips are notoriously difficult to simulate though.
Your presentation is logistically problematically confusing to me for the following reason:
Instead of putting the image files you wanted to be looked at ALL on ONE imgur link and annotating each one (in text) with your observations/perceptions about it, you elected a type of presentation, that is hard (confusing to me) to keep track of.
ORGANIZATION: 3 different tabs must be opened and kept track of to know which one called what in your TEXT link corresponds to what. One called 'this simulation', the next called 'click here' and the other called, 'profile view on the simulation'. When going back to the text in your post and also having the 3 tabs I clicked on, each one says 'imgur, magic of internet'. So, this type of presentation gets confusing to me because it requires me to keep track of which different tab needed to be opened cross references with your question. For example: 'this simulation'= a/G56XSJt. 'click here'=Tu82k9R and 'profile view on the simulation'= a/G56XSJt which is the same as 'this simulation'.
After going through all that, I find that 'click here'=Tu82k9R is (or looks like) the (soft tissue) after proposal of 'this simulation'= a/G56XSJt. Yet 'click here'=Tu82k9R includes a type of displacement read-out that I'm not familiar with. The ones I am familiar with as they apply to CCW-r (posterior down graft) have displacement measures for PNS (posterior nasal spine dropped down). So, I don't see that on the displacement proposal of 'click here'=Tu82k9R.
What I see on the displacement proposal of 'click here'=Tu82k9R is/are listings of 0 rotation for the mandible whereas a CCW-r of the maxilla (via posterior downgrafting) effects an auto rotation of the mandible and also a translation (line distance, 'advancement') BUT under the listing for 'translation' for the mandible, it doesn't list any measures for the proposed advancement. Since he has a field listing for 'auto-rotation' for the mandible where it says 'no movement', from that I would conclude there is no CCW type posterior downgraft rotation in the proposal.
That said, your presentation which was hard to keep track of via the way you organized it in addition to the doctor's ceph read out, that lacks in much clarity is not something I can use to predict a specific outcome. For example, what I said about the different possibilities of unfavorable philtral/upper lip changes being MORE applicable to LARGER advancements to modest ones is generally true. But I can't predict with precision that my mentioning those types RELATIONSHIPS are a predictive guarantee of a person liking what they see in the mirror.
All I can conclude from this presentation is that the visual found on 'click here'=Tu82k9R which is the SAME (after) visual found on 'this simulation'= a/G56XSJt and also 'profile view on the simulation'= a/G56XSJt shows an improvement to the jaw to jaw relationship given that both the upper and lower jaw recession are addressed. Although it doesn't show nose changes, nose changes do come about via the double jaw surgery. Even with only lower jaw changes, the perception of a nose change can come about given that the nose can look different on the face when another part of the face has been changed.
IF you just FOCUS on the SALIENT visual information the surgeon gave you, the before vs. the proposed after, there is an improvement to be seen (well I see a profile improvement). It's not 'problematic' to me that the upper lip doesn't line up (exactly) with the lower. But consider the doctor wants you to look at the proposed (profile) changes yourself and decide whether or not they are 'problematic' to YOU given that you requested to have maxillary advancement included with your surgery.
In closing, I see DOUBLE JAW recession and good possibility of some profile improvement to the dorsum (bridge) and tip to the nose with the maxillary advancement and also the possibility of getting the alar cinch to mitigate extent of nostril widening. As to the 'BIGness' of your nose that GJ pointed out, the lower jaw advancement helps mitigate some bigness by RELATIVE COMPARISON. For example, when plastic surgeons chart out a rhino, if a person, say, has recession at the chin, a chin advancement is offered to 'balance'. So, in the event, you did get some nostril widening in frontal perspective but also some improvement to the bridge (dorsum) and the tip in profile perspective, there is a type of rhino where they do a wedge resection to the alar rims to reduce excess width. So, what I'm saying is that there is a contingency plan in the event of the possibility that GJ is concerned about. However, if you are concerned about the possibility of nose base width increase as much as he is, then of course the option is there to just go with the single (lower jaw) surgery. What I can tell you is that there is a type of rhino operation (alar resection) in that event.
