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Aesthetics / Re: Opinions on my plan
« Last post by kavan on Today at 12:26:33 PM »



Quote from: GJ on May 29, 2024, 09:50:38 AM
That's a huge movement and probably not justified bases on the scan you posted. The ANS can be trimmed to help with protrusion, to some extent.

The nose protrusion he has is to the TOP of the nose bone. Not the base ; ANS.  The surgeon told him he had a hanging columella due to lack of support under the nose. So, you would NOT trim the ANS for that since it supports the base of the nose. Trimming the ANS in someone with a hanging columella stands to collapse support for the base of the nose. The protrusion to his nose bone that his surgeon is advancing the maxilla relative to is area to the TOP of his nose bone that is sticking out. He's got a photo up pointing to where it exactly is.
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General Chat / Re: Suggested plan by Dr Ramieri Italy
« Last post by kavan on Today at 11:52:47 AM »
As to 3/4 view:

The head pose (to the right) should be turned somewhat more to the left for the full 3/4 view and visa versa.

When I used to morph people to show improved contour changes, my requirement was that the 3/4 view for the ogee curve was to pose without the nose getting in the way and for both eyes to show. Basically, the head pose needed to conform with the artistic principles of how to draw a human head in 3/4 view. If not, the person's actual ogee curve is not completely in the field it needs to be viewed in and subsequently alter it. Your pose has the eye area blacked out and the nose in the way.

I see what you mean by the curve contour below the nose making it look somewhat like an underbite. It could be an artifact (type of hiccup in soft ware program). But just to say, it's a problematic perspective to view the true 3/4 perspective and also to morph it from. See if you have the option for him to show you from a true 3/4 perspective. If not, show him what you're seeing and ask if that particular perspective kicked up a 'hiccup'.

Anyway, the SALIENT perspective to look for an underbite contour is the PROFILE perspective. A maxfax guy is usually going to make sure the profile posture of the head is right (correct) for that one and software predictive programs have an easier time with those.

As to Alfaro, I think he's 'straight out' with it in the sense that you really don't 'need' surgery. Like you could 'survive aesthetically' if you didn't have any. He's also straight out with it to say on the morph proposal that it depicts the direction he's going in.

I think Ramieri might be a better choice for you especially IF he let's you play with the design program to show what you like. But I think the profile and frontal perspectives are the better ones to base your decision on rather than the 3/4 perspective which is not exactly a 'true' 3/4 pose.


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General Chat / Suggested plan by Dr Ramieri Italy
« Last post by strongjawman on Today at 05:05:17 AM »
Visually speaking, what do you think?

I noticed that it looks decent from the profile view but from the 3/4 it appears that I almost have an underbite..? Has changed the ogee curve relationship. Wondering if the software is not giving an accurate representation.

Plan is CCW, posterior downgraft of ~4mm, maxillary advancement of 3mm and it appears almost 12mm at the longest point of mandibular advancement. This seems like too much for my taste but he advised that the 3d soft imaging usually appears 20% more advanced than it would be in reality...

From the front the slight maxillary cant is corrected and the left mandible is advanced slightly more than right in order to correct incisor midline. The ramus on each side was also suggested to be widened about 4mm on each side, which he said would give a similar appearance to having implants.

All of this is done prior to any orthodontic work. In contrast, Dr Alfaro in Spain suggested I would need orthodontic treatment first however after a series of questions on my part regarding the treatment, he told me he didnt think I needed surgery.

Dr Ramieri on the other hand essentially lets you play around with the 3D planning/cuts with how you want it to be and then gives his opinion which I actually liked.

Here are the images from Dr Ramieri in Rome: https://imgur.com/a/ow9XnNN

Here are a couple of photoshopped pre planning images Dr Aflaro gave me: https://imgur.com/a/gJjySUO and https://imgur.com/MD3WoIV
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Aesthetics / Re: Why such little extra tooth show? Anterior downgrafting
« Last post by kavan on May 29, 2024, 08:30:53 PM »
Quote from: SV123 on May 29, 2024, 08:05:00 PM
Hi Kavan,

thanks for the response. Here is a picture of my simulation which shows the two downgrafts

Then it would have to do with combined or competing rotations.
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Aesthetics / Re: Why such little extra tooth show? Anterior downgrafting
« Last post by SV123 on May 29, 2024, 08:06:52 PM »
Quote from: GJ on May 29, 2024, 09:47:23 AM
My guess would be you have a long lip/a lot of soft tissue. Also, 2.5mm is a lot...

Ah ok. I just want to make sure I am getting the right amount of anterior downgraft for my SFS case.
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Aesthetics / Re: Why such little extra tooth show? Anterior downgrafting
« Last post by SV123 on May 29, 2024, 08:05:00 PM »
Hi Kavan,

thanks for the response. Here is a picture of my simulation which shows the two downgrafts
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Functional Surgery Questions / Re: SARPE while MMA for better breathing
« Last post by kavan on May 29, 2024, 06:21:22 PM »
Quote from: jawguy14 on May 28, 2024, 02:51:45 AM
I made the text that extensive because I tried to convey my thought process in as much detail as possible.

To put it more simple: What are the odds that palate expansion (via a expander device) will impact the nasal cavity if expansion is performed shortly after DJS with CCW and posterior downgraft. Regarding the stability of the area, where the LF1 took place and the skull and the maxilla are now connected to the additional bone of the downgrafting.

Try thinking in terms of getting the palate expander IF you need a wider palate for say a better smile like if you have buccal corridors hiding the back of your smile. If in addition to  it widening the palate it also helps nasal breathing than great.
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Aesthetics / Re: Why such little extra tooth show? Anterior downgrafting
« Last post by kavan on May 29, 2024, 10:58:46 AM »
I REMOVED my prior entry which was my GUESS of as to why 'only getting 2.5mm upper tooth show'. I removed it because in hind site I was THROWN FOR A LOOP when the OP 'clarified' the downgraft measures to the posterior and anterior maxilla as being 10.5mm posterior downgrafting and 6.8 anterior downgrafting. Yet NO SUCH measures were listed on the displacement proposal.

So as to the question of :'... why am I only getting an extra 2.5mm of tooth show from the 6.8mm anterior downgrafting? Does the 10.5mm posterior downgrafting counter act the tooth show to some degree?', in retrospect was an invalid one to ask given the displacement proposal  NEITHER lists a 10.5mm posterior downgraft NOR a 6.8 anterior downgraft. So, I removed my response to the OP's question.

The actual displacement proposal cites 3.23 for ANS and 8.77 for PNS. Nothing in it about any 6.8 and 10.5.  Only the advancement at the pogonian cites a 10.5 measure.
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Functional Surgery Questions / Re: Improved nasal breathing through downgraft
« Last post by GJ on May 29, 2024, 09:55:50 AM »
If you get CCW then the volume increase is going to be in the lower airway, which is what you want for apnea. To get more volume in the upper airway you'd have to move it linearly, though, maybe moving it down would do that, too. I'm not sure on that but it does make sense.
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Functional Surgery Questions / Re: SARPE while MMA for better breathing
« Last post by GJ on May 29, 2024, 09:53:45 AM »
Quote from: jawguy14 on May 28, 2024, 02:51:45 AM
I made the text that extensive because I tried to convey my thought process in as much detail as possible.

To put it more simple: What are the odds that palate expansion (via a expander device) will impact the nasal cavity if expansion is performed shortly after DJS with CCW and posterior downgraft. Regarding the stability of the area, where the LF1 took place and the skull and the maxilla are now connected to the additional bone of the downgrafting.

I'm not convinced palate expansion is possible with stable results in adults, and might even cause complications to the tissue, etc. How old are you?
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