I'd like to get some feedback on my surgery plan with Dr. Ramieri

[DarrenG]

I'm planning on getting double jaw surgery with Dr. Ramieri to correct multiple flaws in my appearance. I had my video consultation with him in 2024, and now I'm finished with the pre-surgical orthodontics, the surgeon has my CBCT scans and he's sent me a surgical plan for me to evaluate.

My facial flaws are as follows:

1). midline deviation (2mm)
2). overjet
3). asymmetric mandible (one jaw corner is "rounded", the other is "square")
4). vertical maxillary deficiency (limited upper tooth show)
5). flat occlusal plane (2.8°, this gives me a "flat" smile line, rather than a curved smile line, in which the lower edge of the upper teeth follow the upward curve of the lower lip)
6). lips that appear thin and downturned, creating a "saddened" appearance.

Here's a link to the surgeon's plan:

https://drive.proton.me/urls/44N7RFZ6VW#pZl6heqxgUDb

As you can see, his plan corrects the first three problems perfectly. I'm just not certain about other things though:

He set the occlusal plane to 8.0°. I requested that number because based on my research, the ideal range is 4 - 12, with 8 being the ideal (I could be wrong). I'd like to create a nice smile arc.

He downgrafts my maxilla, doing 8 mm in the front and 6 mm in the back, increasing the height of my lower facial third, and increasing upper tooth show. The rotation increases my occlusal plane angle.

Points of Concern:

Measurement (°)                            Pre-Operative 3D                 Planned 3D                         Delta 3D

SNA                                                    86.5                                       87.1                                      0.5
SNB                                                    84.4                                       85.3                                      1.0
ANB                                                    2.2                                         1.9                                       -0.3

Maxillary Occlusal Plane                    2.8                                         1.2                                       -1.6

If you look at the "Measurement" panel on Page 17, which I've reproduced above, all the numbers look a bit odd, the SNA/SNB values have both increased, even though they were already higher than normal values of 82° +/- 2° and 80° +/- 2°, respectively. Is something wrong here? Shouldn't the SNA/SNB numbers be decreasing, rather than increasing? (The occlusal plane angle is listed as being 1.4° post-operatively, which is probably a typing error)

For what it's worth, I was told by one of the orthodontists that I consulted with, that I have "bimaxillary retrusion". Could this be what's going on with my SNA/SNB angles? Many examples of surgical correction of a "short face growth pattern" involve not only downgrafting and rotating, but also a horizontal advancement of both jaws. It also makes me wonder if my lips would appear fuller if the jaws were moved forwards, or if that unnecessary.

Questions:

1). If I advanced both jaws, rather than just the lower jaw, would it:

-improve my nasolabial angle?
-affect my nose negatively?
-improve the appearance of my lips?
-correct my SNA/SNB angles?

I'm basically just want to know if I'd benefit from horizontal advancement.

2). Is the occlusal angle of 8.0° ideal for my smile arc, or does the ideal occlusal angle vary with each individual? Should I have chosen a different angle?

I've attached links to two photo galleries. The first link comprises the 20 or so miscellaneous photos I sent to my surgeon; my mouth shape, CBCT scans, surgical example photos, et cetera.

https://imgur.com/a/Gd2Pqvr

The second link is a set of 9 professional photos of my face from various different angles.

https://imgchest.com/p/ne7brpnajy5

Here's a link to my previous thread from 2024.

https://jawsurgeryforums.com/index.php/topic,8726.msg80326.html#msg80326




Thank you!

[GJ]

There's a lot of information here. In fact, too much for me to go through in detail.

In cursory looking at the scans and photos, it looks to me like you need your face elongated. If the plan is moving the jaws slightly forward and down then it's probably the correct plan. Get at least three consults to confirm the movements are correct. But that would be my interpretation.

[DarrenG]

Thanks for your reply. "Slightly forward" is exactly what I was thinking. It would make sense that someone that didn't grow downwards like they were supposed to, also didn't grow far enough forwards, just like how people with severe jaw issues in general can also end up with underdeveloped of the cheekbones.