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Option 1:

1. Bimax ( see the plan at the end) and mandible shaving, due to the protruding mandible border.
- linear advancement (maxilla 5mm, the plan states 2-3mm, but it will probably end up being 5-6mm after revision of the plan, in order to correct overjet.

I actually meant to say: the plan is linear advancement of both jaws.
- 5mm in the maxilla,
- 2-3mm in the mandible according to the current plan. But I have spoken to the surgeon and told him to correct my 4mm overbite as well. For this reason the mandible will be advanced around 6-7mm in the end. 

Hey guys,

My history: I’m a class 2 patient, 4mm overbite, deep bite, had chin wing 3 years ago. Mandible plane was decreased and chin was advanced about 5-6mm. Chin was rotated ccwr, making the whole face shorter and giving me that classic short face look. 

Horrible results, protruding mandible border, high chin fold. Now I have to reverse the damage.

I'm pretty sure I'm not a classic short face patient, since already have a light gummy smile, when I smile or laugh. Does this indicate that i do not suffer from vertical maxillary deficiency? For this reason, a surgeon told me that downgrafting of the maxilla or clockwise rotation of both jaws is not possible, since it would increase the gummy smile.

My occlusional plane is already quite flat, which is a reason why my surgeon didn't want to add any ccw-rotation. The consulted surgeon routinely does ccwr movements for sleep apnea cases, so this recommendation was not due to his personal limitations in surgery.

My mandible plane was made flatter during the chin wing surgery, since a bone graft was added in between the cut.

As of now there are two options:


Option 1:

1. Bimax ( see the plan at the end) and mandible shaving, due to the protruding mandible border.
- linear advancement (maxilla 5mm, the plan states 2-3mm, but it will probably end up being 5-6mm after revision of the plan, in order to correct overjet.

2. 1 year later revision genio: 2-3mm horizontal reduction, downgraft or deprojection of the pog


Option 2:

Would be to combine those two steps in one surgery. Which might be detrimental to the aesthetic result, since planning cant be as exact.

My questions:

1. Is linear advancement really the only option? My surgeon said no rotation possible, because of flat OP. No downgraft possible because of light gummy smile. Is there anything else in my case, that indicates a linear advancement?

2. Is there any way to down graft the maxilla without worsening the gummy smile?

3. Based on my recession, are 5mm linear maxillary advancement adequate? I'm afraid it might be to too much. Please don't base this question on the convexity of my current nose, since i had a rhinoplasty years ago as well. For this reason, I included an image of my face before all the surgeries in the link. I'm well aware that I will probably require another rhino after maxillary advancement. So please do not base your judgements of the maxillary advance length on my current nose, but rather on the original one, which was very convex and large.


Pictures, Scans and Surgery Plan:
https://imgur.com/a/aegcDPc

Greatly appreciate any piece of advice

Probably chin reduction will be the best way. You are basically wanting your jaw to be more recessed?

The plan doesn't change your forehead. It's a double jaw surgery that advances your recessive midface area and also advances your lower jaw. So the areas that are NOT the forehead being ADVANCED would most certainly not make your forehead look relatively larger. Quite the contrary, the DJS advancement would tend to make the forehead look  less advanced by relative comparison.

I see one frontal scan, which isn't enough.

I don't have more. Sadly 😭