jawsurgeryforums.com
General Category => Aesthetics => Topic started by: TheGerman on June 19, 2022, 08:16:16 AM
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I'm rather new to osteotomies/maxillofacial surgeries but I know I probably need some form of ccwr trimax. I believe I was made way uglier by the treatment plan of my orthodontist. I had braces from 14 to 18 years. They extracted all of my canine teeth and I also had to wear elastics. I need to know how I can fix my ruined occlusion and my facial aesthetics. Most important questions in my opinion are:
-Do I need decompensation before jaw surgery?
-Do I need some form of jaw widening either by ramus widening or with jaw angle implants later?
-What movements are the right ones for my case?
-Is the damage done by my ortho reversible?
-Besides ccwr trimax, do I need anything else to fix my skull/face? General feedback to my skull would be nice
-What surgeon would you recommend for my case?
I have pics of my face (sadly low quality) and pics of my cbct scan:
https://imgur.com/a/un94GGc (cbct)
https://imgur.com/a/5SKNyZo (face)
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The only thing I can say: It seems you have a rather big nasolabial angle. If you move the upper jaw forward the angle could get more obtuse.
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The only thing I can say: It seems you have a rather big nasolabial angle. If you move the upper jaw forward the angle could get more obtuse.
So you mean it would make it's appearance even worse? But wouldn't ccw rotation and maybe proclining my upper incisors help with the bad angle?
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Main issue here is that you have a prominent nasal spine (ANS) which is the thing that contributes to the appearance of your lower jaw looking relatively recessed compared to your upper jaw. So, ANS would need to be cutdown/reduced. That would resolve to what's called a DEPROJECTION RHINOPLASTY. So, if you got that, your lower jaw area would look MORE in balance with the upper jaw.
With the PROMINENT ANS as it is now, you would look TERRIBLE if the upper jaw was advanced BUT the ANS was not reduced in the process. So IF you got a double jaw surgery and ALSO IF the upper jaw needed to be advanced to 'mesh' with a lower jaw advancement, you would need to have a surgeon who could DEPROJECT the ANS as part of the process.
Most jaw surgeries for people who have had prior ortho (or even those who have not), the bite needs to be DECOMPENSATED. But INSTEAD of using that term, let's keep it SIMPLE and just say it's more likely than not that the teeth will need to be put in BRACES to prepare for the displacements of the surgery.
Aesthetically speaking, you look like a candidate for SINGLE lower jaw surgery and deprojection rhinoplasty. It's also looking like if you found a good rhino surgeon to perform the deprojection rhino and did that first, your lower jaw would look LESS recessive than it does now when compared to the prominent ANS that makes your upper jaw look too PROTRUSIVE, in which case, you could re-evaluate the jaw balance and perhaps decide not to get a single lower jaw advancement at all.
In closing your PROMINENT ANS is what's throwing off aesthetic jaw to jaw balance and contributing to the LOOK/appearance of your maxila area looking TOO protrusive which in turn makes your lower jaw look retrusive via RELATIVE COMPARISON.
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So you mean it would make it's appearance even worse? But wouldn't ccw rotation and maybe proclining my upper incisors help with the bad angle?
YES, you would look worse. Because your 'overly obtuse' nasiolabial angle is due to your overly protrusive anterior nasal spine (ANS). I've addressed that in my recent post to you. Tomas john is CORRECT. Advancement of the upper jaw would make you look WORSE and for it not to you would need REDUCTION of the ANS.
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Main issue here is that you have a prominent nasal spine (ANS) which is the thing that contributes to the appearance of your lower jaw looking relatively recessed compared to your upper jaw. So, ANS would need to be cutdown/reduced. That would resolve to what's called a DEPROJECTION RHINOPLASTY. So, if you got that, your lower jaw area would look MORE in balance with the upper jaw.
With the PROMINENT ANS as it is now, you would look TERRIBLE if the upper jaw was advanced BUT the ANS was not reduced in the process. So IF you got a double jaw surgery and ALSO IF the upper jaw needed to be advanced to 'mesh' with a lower jaw advancement, you would need to have a surgeon who could DEPROJECT the ANS as part of the process.
Most jaw surgeries for people who have had prior ortho (or even those who have not), the bite needs to be DECOMPENSATED. But INSTEAD of using that term, let's keep it SIMPLE and just say it's more likely than not that the teeth will need to be put in BRACES to prepare for the displacements of the surgery.
Aesthetically speaking, you look like a candidate for SINGLE lower jaw surgery and deprojection rhinoplasty. It's also looking like if you found a good rhino surgeon to perform the deprojection rhino and did that first, your lower jaw would look LESS recessive than it does now when compared to the prominent ANS that makes your upper jaw look too PROTRUSIVE, in which case, you could re-evaluate the jaw balance and perhaps decide not to get a single lower jaw advancement at all.
In closing your PROMINENT ANS is what's throwing off aesthetic jaw to jaw balance and contributing to the LOOK/appearance of your maxila area looking TOO protrusive which in turn makes your lower jaw look retrusive via RELATIVE COMPARISON.
Interesting insight. I have never read too much about the ANS but always felt like my ANS was in the normal range. However I've always been somewhat irritated by the fact that my nose base is infront of my browridge even though my mandible and also my maxilla look kinda recessed. For the TRIMAX surgery the Dr. I consulted with said he wouldn't do any advancement on the upper jaw, only rotation, which would result in an "advancement" of the ANS by about 2mm. Other movements would be 8mm BSSO and 6mm wedge cut genio + 4-5mm ramus widening on each side. Is that a way of fixing things? Because I don't think there are many surgeons that I want working on my ANS..seems risky.
I think my biggist issue is downward growth tbh.
Here is the plan the Dr. proposed:
https://imgur.com/a/wkq0B2c
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your imgur acccount makes people sign in. if your nose base is in front as you say, THAT means prominent ANS. it also shows on your bone scan model. again, advancement of the ANS will make you look WORSE. that is the salient info.
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your imgur acccount makes people sign in. if your nose base is in front as you say, THAT means prominent ANS. it also shows on your bone scan model. again, advancement of the ANS will make you look WORSE. that is the salient info.
I don't know how to change the signing in stuff.
But trimax without advancing upper jaw would be a solution right?
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I don't know how to change the signing in stuff.
But trimax without advancing upper jaw would be a solution right?
Communication here is not working out for the following reasons:
1: I've given you my advice already.
2: I will not be communicating in terms of 'TRIMAX' because the word implies someone has 3 (three) jaws and not 2 (two).
3: My explanations about the ANS being a key issue were sufficient enough for someone of average intelligence/comprehension ability to FIGURE OUT on their own that a proposed CCW rotation at the upper jaw involving the ANS projecting out FURTHER (in a circumstance where the doctor made CLEAR a CCW rotation at maxilla would project out the ANS more) would make someone with a protrusive ANS look WORSE.
That said, your last (and FINAL) question/conclusion to me suggests inability to 'digest' very straight forward information and has resulted in my electing to DISCONTINUE further advice.
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Communication here is not working out for the following reasons:
1: I've given you my advice already.
2: I will not be communicating in terms of 'TRIMAX' because the word implies someone has 3 (three) jaws and not 2 (two).
3: My explanations about the ANS being a key issue were sufficient enough for someone of average intelligence/comprehension ability to FIGURE OUT on their own that a proposed CCW rotation at the upper jaw involving the ANS projecting out FURTHER (in a circumstance where the doctor made CLEAR a CCW rotation at maxilla would project out the ANS more) would make someone with a protrusive ANS look WORSE.
That said, your last (and FINAL) question/conclusion to me suggests inability to 'digest' very straight forward information and has resulted in my electing to DISCONTINUE further advice.
Trimax is a normal term for bimax + genio? Also no need to be so unfriendly since I can't just shave off my ANS or anything. I have seen alot of cbcts and many caucasians hat similar ANS projection like I did
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Trimax is a normal term for bimax + genio? Also no need to be so unfriendly since I can't just shave off my ANS or anything. I have seen alot of cbcts and many caucasians hat similar ANS projection like I did
Probably a normal term in the looksmax online community, correct?
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Probably a normal term in the looksmax online community, correct?
I’ve seen a multitude of surgeons use the term “Trimax”
What’s your point?
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I’ve seen a multitude of surgeons use the term “Trimax”
What’s your point?
I am curious where the term is coming from. When i looked it up online it lead me to those sites.
Its always interesting to see how the internet influences those things.
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I am curious where the term is coming from. When i looked it up online it lead me to those sites.
Its always interesting to see how the internet influences those things.
It's a marketing term used by some doctor in Europe. I guess the TARGET market would be those who think they have 3 jaws or might not realize the extra jaw of the 3 would be the chin.
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Probably a normal term in the looksmax online community, correct?
I saw it on these kind of forums too but first heard of it from Doctors
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Main issue here is that you have a prominent nasal spine (ANS) which is the thing that contributes to the appearance of your lower jaw looking relatively recessed compared to your upper jaw. So, ANS would need to be cutdown/reduced. That would resolve to what's called a DEPROJECTION RHINOPLASTY. So, if you got that, your lower jaw area would look MORE in balance with the upper jaw.
With the PROMINENT ANS as it is now, you would look TERRIBLE if the upper jaw was advanced BUT the ANS was not reduced in the process. So IF you got a double jaw surgery and ALSO IF the upper jaw needed to be advanced to 'mesh' with a lower jaw advancement, you would need to have a surgeon who could DEPROJECT the ANS as part of the process.
Most jaw surgeries for people who have had prior ortho (or even those who have not), the bite needs to be DECOMPENSATED. But INSTEAD of using that term, let's keep it SIMPLE and just say it's more likely than not that the teeth will need to be put in BRACES to prepare for the displacements of the surgery.
Aesthetically speaking, you look like a candidate for SINGLE lower jaw surgery and deprojection rhinoplasty. It's also looking like if you found a good rhino surgeon to perform the deprojection rhino and did that first, your lower jaw would look LESS recessive than it does now when compared to the prominent ANS that makes your upper jaw look too PROTRUSIVE, in which case, you could re-evaluate the jaw balance and perhaps decide not to get a single lower jaw advancement at all.
In closing your PROMINENT ANS is what's throwing off aesthetic jaw to jaw balance and contributing to the LOOK/appearance of your maxila area looking TOO protrusive which in turn makes your lower jaw look retrusive via RELATIVE COMPARISON.
By the way, thanks. Always cool to hear about this stuff. First time I heard about the nasal spine for example. It would be really cool if there is a checklist / guideline for users if one wants to analyze his/her or other faces that includes all those details.
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By the way, thanks. Always cool to hear about this stuff. First time I heard about the nasal spine for example. It would be really cool if there is a checklist / guideline for users if one wants to analyze his/her or other faces that includes all those details.
Glad to hear that, as usual, you are receptive and understand the info I provide. You observed the large nasolabial angle and predicted the angle would get more obtuse with advancement and no conceptual problem for you to relate the large NLA to the prominent ANS when that was mentioned. However, as you have seen on this thread, when ever I provide info to the OP which I break down to make as intuitive as possible and then I find they can't 'digest' it, I give up on those types.
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Glad to hear that, as usual, you are receptive and understand the info I provide. You observed the large nasolabial angle and predicted the angle would get more obtuse with advancement and no conceptual problem for you to relate the large NLA to the prominent ANS when that was mentioned. However, as you have seen on this thread, when ever I provide info to the OP which I break down to make as intuitive as possible and then I find they can't 'digest' it, I give up on those types.
I don't know why you imply I am dumb I simply don't really agree? I don't think shaving the ANS is a good idea. My main problem seems to be downward growth.
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I don't know why you imply I am dumb I simply don't really agree? I don't think shaving the ANS is a good idea. My main problem seems to be downward growth.
I have no objection to what ever you think the solution to your problem is.
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I have no objection to what ever you think the solution to your problem is.
I have consulted surgeons and I will consult a few more. Noone mentioned ANS shaving. So make of that what you will
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I have consulted surgeons and I will consult a few more. Noone mentioned ANS shaving. So make of that what you will
Du solltest lieber dein Leben leben und diese ganze Geschichte schleunigst vergessen, bevor du dich in irgendwas hier rein reitest.
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Du solltest lieber dein Leben leben und diese ganze Geschichte schleunigst vergessen, bevor du dich in irgendwas hier rein reitest.
Was meinst du? Ich brauche doch bimax + genio, wo ist das Problem? Lebe ja trotzdem mein Leben müsste halt nur etwas Geld nebenbei ansparen. Wo soll man sich denn reinreiten?
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After this answer it is obvious, that you have no clue about the seriousness of this processing. Saying, that something is "needed" in this forum, is obvious wrong. Your life does not depend on it. Lass es gut sein, bevor du dir ernsthafte Schäden zufügen lässt.
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After this answer it is obvious, that you have no clue about the seriousness of this processing. Saying, that something is "needed" in this forum, is obvious wrong. Your life does not depend on it. Lass es gut sein, bevor du dir ernsthafte Schäden zufügen lässt.
Ich verstehe wirklich nicht was du meinst. Ich bin recessed und downward grown, das ist halt Fakt. Wie soll ich mir damit Schäden zufügen, wenn ich in Erwägung ziehe, zu einem der weltbesten Chirurgen zu gehen? Was soll ich denn sonst sagen, brauchen tut man nur die wenigsten Dinge, aber bei mir liegt ein Problem vor, das ich eben gerne lösen würde.
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Sometimes I think, that kavan is too harsh, but in this case he is totally right to stop communication.
This will be my last reply: You are one of this people, who are many in this world, who think, that some surgeons with a big reputation understand everything. That is not the case, many jaw surgeons don't have any clue about ANS or even if they have, they don't perform any surgery to reduce it. You have to understand, that surgeons just learn something and apply it. They aren't special. Myself have a academic background and I only have clue about my specific topic, but I am an average human if it comes to other topics even if it is same subject, which I studied.
Surgeons will always tell you what they learnt and glorifie their specific skills. You have the big luck, that someone like kavan tells you some serious alternatives, which no maxfac surgeon have ever told you. Either you wake up from your childlish dream, that doctors are "halbgötter in weiß" or go for the so called "world-best surgeon" and get your face change and be happy for some months, because you just changed your face and fall into a deep hole after realising, that you looked better and got now maybe even some issues due to the surgery itself.
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Gadwins,
Thank you for your entry here. You've given some good cautionary advice. It's true that I'm harsh. But that's usually AFTER a post where I provide enough about what the main problem is and find the person is not receptive to the info provided. At that point, I leave them to their own devices.
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Sometimes I think, that kavan is too harsh, but in this case he is totally right to stop communication.
This will be my last reply: You are one of this people, who are many in this world, who think, that some surgeons with a big reputation understand everything. That is not the case, many jaw surgeons don't have any clue about ANS or even if they have, they don't perform any surgery to reduce it. You have to understand, that surgeons just learn something and apply it. They aren't special. Myself have a academic background and I only have clue about my specific topic, but I am an average human if it comes to other topics even if it is same subject, which I studied.
Surgeons will always tell you what they learnt and glorifie their specific skills. You have the big luck, that someone like kavan tells you some serious alternatives, which no maxfac surgeon have ever told you. Either you wake up from your childlish dream, that doctors are "halbgötter in weiß" or go for the so called "world-best surgeon" and get your face change and be happy for some months, because you just changed your face and fall into a deep hole after realising, that you looked better and got now maybe even some issues due to the surgery itself.
It's not like I don't think the additional input is good but in the end I need a surgeon that has a clue about the stuff he will perform on me and the surgeon also needs to agree to do it. I looked into ans shaving online and aesthetically speaking it looks like a risky procedure, way more room for big errors than a bimax already has (only aestheticwise).
Also top tier surgeons are way more likely to know about this stuff. If I want a good result who else should I go to besides surgeons with much experience and good reputation?
I 100% need surgery and I am just trying to get it done right. I will book two more consultations and specifically ask the surgeons about the ANS situation
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Here is the deal with an ANS prominence situation:
It is best addressed by a good rhinoplasty surgeon who would be in the capacity to ALSO make further adjustments to the nose. That's because reducing a prominent ANS is PART of what is called a DEPROJECTION RHINOPLASTY. It isn't the 'all' of the deprojection rhino.
For that reason, the surgeon performing the maxfax procedure would ALSO have to be conversant in RHINOPLASTY (good at it) and enough so to make further adjustments to the nose which might have to be performed along WITH the reduction of the ANS. Otherwise, the surgeon will have to work around the prominent ANS situation.
If the maxfax surgeon, especially in a case of DOUBLE JAW surgery is NOT conversant in performing a DEPROJECTION RHINO, than that could LIMIT the type of CCW that can be performed and the extent the maxilla can be brought forward. So, the person getting the CCW would need to have a situation where he/she was a candidate for the type of CCW-r that brings the ANS somewhat BACKWARDS and also a situation where the maxilla was not brought forward.
For example:
1: Forward advancement of the maxilla in a double jaw surgery.
IF the maxilla needed to be brought forward to maximize the extent the lower jaw could be brought forward, the aesthetic TRADE-OFF with maximizing lower jaw advancement would be unfavorable aesthetic changes to the base of the nose (because the ANS already prominent would come more forward and look WORSE).
2: CCW-r around the ANS point.
IF CCW-r around the ANS point is needed to maximize the extent the lower jaw can be brought forward, the ANS stays where it is (in its prominent position) but the soft tissue of the lips will go more forward.
3: CCW-r around the incisor point.
IF CCW-r around the incisor point is needed to maximize the extent of the lower jaw can be brought forward, then that would bring the ANS backwards and and soft tissue projection of nose base (including upper lip) would remain the same.
CONCLUSION: In light of the above relationships, someone with a prominent ANS wanting to KEEP the ANS as is AND ALSO wanting/needing double jaw surgery to maximize lower jaw advancement would also need to be a candidate for CCW around the incisor point but with no added maxilla advancement.
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Here is the deal with an ANS prominence situation:
It is best addressed by a good rhinoplasty surgeon who would be in the capacity to ALSO make further adjustments to the nose. That's because reducing a prominent ANS is PART of what is called a DEPROJECTION RHINOPLASTY. It isn't the 'all' of the deprojection rhino.
For that reason, the surgeon performing the maxfax procedure would ALSO have to be conversant in RHINOPLASTY (good at it) and enough so to make further adjustments to the nose which might have to be performed along WITH the reduction of the ANS. Otherwise, the surgeon will have to work around the prominent ANS situation.
If the maxfax surgeon, especially in a case of DOUBLE JAW surgery is NOT conversant in performing a DEPROJECTION RHINO, than that could LIMIT the type of CCW that can be performed and the extent the maxilla can be brought forward. So, the person getting the CCW would need to have a situation where he/she was a candidate for the type of CCW-r that brings the ANS somewhat BACKWARDS and also a situation where the maxilla was not brought forward.
For example:
1: Forward advancement of the maxilla in a double jaw surgery.
IF the maxilla needed to be brought forward to maximize the extent the lower jaw could be brought forward, the aesthetic TRADE-OFF with maximizing lower jaw advancement would be unfavorable aesthetic changes to the base of the nose (because the ANS already prominent would come more forward and look WORSE).
2: CCW-r around the ANS point.
IF CCW-r around the ANS point is needed to maximize the extent the lower jaw can be brought forward, the ANS stays where it is (in its prominent position) but the soft tissue of the lips will go more forward.
3: CCW-r around the incisor point.
IF CCW-r around the incisor point is needed to maximize the extent of the lower jaw can be brought forward, then that would bring the ANS backwards and and soft tissue projection of nose base (including upper lip) would remain the same.
CONCLUSION: In light of the above relationships, someone with a prominent ANS wanting to KEEP the ANS as is AND ALSO wanting/needing double jaw surgery to maximize lower jaw advancement would also need to be a candidate for CCW around the incisor point but with no added maxilla advancement.
Appreciate the input. I guess I understand your point better than before. I definitely need to look for a capable rhinoplasty surgeon that teams up with a maxfac..
I had a consultation with an Italian maxfac a while ago. Sadly he didn't tell me what point will be the centre of his proposed ccwr bimax. It's not really possible for me to tell from the simulations but maybe you can tell. Otherwise I will consult with him again and ask him for more details. His planned movements are: upper jaw only ccwr of 7 degrees which would result in a 2mm increase of the forward projection of the ANS. 8mm BSSO. 4mm ramus widening on the one and 5mm ramus widening on the other side. 6mm genio with downgrafting.
Here is the plan he gave me:
https://imgur.com/a/wkq0B2c
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Appreciate the input. I guess I understand your point better than before. I definitely need to look for a capable rhinoplasty surgeon that teams up with a maxfac..
I had a consultation with an Italian maxfac a while ago. Sadly he didn't tell me what point will be the centre of his proposed ccwr bimax. It's not really possible for me to tell from the simulations but maybe you can tell. Otherwise I will consult with him again and ask him for more details. His planned movements are: upper jaw only ccwr of 7 degrees which would result in a 2mm increase of the forward projection of the ANS. 8mm BSSO. 4mm ramus widening on the one and 5mm ramus widening on the other side. 6mm genio with downgrafting.
Here is the plan he gave me:
https://imgur.com/a/wkq0B2c
Can't see your IMGUR plan because it's set up for people to sign in and I'm not an IMGUR member.
Any increase to the ANS projection will make an already prominent ANS more prominent.
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Can't see your IMGUR plan because it's set up for people to sign in and I'm not an IMGUR member.
Any increase to the ANS projection will make an already prominent ANS more prominent.
Cant he avoid the nose changes by getting a subspinal lefort?
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Can't see your IMGUR plan because it's set up for people to sign in and I'm not an IMGUR member.
Any increase to the ANS projection will make an already prominent ANS more prominent.
I tried to send you a private message I hope it worked. This forum is so weird to use. Let's try to find a way I can share the pictures with you.
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I tried to send you a private message I hope it worked. This forum is so weird to use. Let's try to find a way I can share the pictures with you.
I SAW your IMGUR photos and some scans which were in your FIRST post and it looked like I SAID was the case. It's the PLAN the doctor gave which is on some IMGUR link that requires a sign in which I can't see. HERE is the PLAN link you would need to make visible publicly: " Here is the plan he gave me":
https://imgur.com/a/wkq0B2c
The board lets you ATTACH photo files which you will see as 'Attachments and other options' where you can choose a file to upload on the board. (It's right below where you type in a post.) So, try clicking on that to upload your PLAN that can't be viewed on one of your IMGUR links. Otherwise I won't be able to see your PLAN; the PLAN the doctor gave. Your face photos and your scans are NOT 'plans' and AGAIN, I already gave advice based on those.
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I SAW your IMGUR photos and some scans which were in your FIRST post and it looked like I SAID was the case. It's the PLAN the doctor gave which is on some IMGUR link that requires a sign in which I can't see. HERE is the PLAN link you would need to make visible publicly: " Here is the plan he gave me":
https://imgur.com/a/wkq0B2c
The board lets you ATTACH photo files which you will see as 'Attachments and other options' where you can choose a file to upload on the board. (It's right below where you type in a post.) So, try clicking on that to upload your PLAN that can't be viewed on one of your IMGUR links. Otherwise I won't be able to see your PLAN; the PLAN the doctor gave. Your face photos and your scans are NOT 'plans' and AGAIN, I already gave advice based on those.
I hope the link works now:
https://imgur.com/a/wroEXY7
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I hope the link works now:
https://imgur.com/a/wroEXY7
Does NOT work for me. Still needs a sign in. Sorry, but too much time is being spent discussing NOT seeing the plan. You will need to just upload it on the board if you want me/others to look at it. See if SOMEONE ELSE can see it and copy it onto the board. Otherwise, I already gave you directions as to HOW to enter the plan publicly on the board OR try another photo image uploading site.
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Does NOT work for me. Still needs a sign in. Sorry, but too much time is being spent discussing NOT seeing the plan. You will need to just upload it on the board if you want me/others to look at it. See if SOMEONE ELSE can see it and copy it onto the board. Otherwise, I already gave you directions as to HOW to enter the plan publicly on the board OR try another photo image uploading site.
Google drive might work:
https://drive.google.com/drive/folders/1qtvd3HiqGy1SrXTFB1OqLycSNhU43aNn?usp=sharing
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Google drive might work:
https://drive.google.com/drive/folders/1qtvd3HiqGy1SrXTFB1OqLycSNhU43aNn?usp=sharing
OK. I got to the new place you stored your files.
What I was looking for specifically was the PLAN READOUT which is a readout of all the areas displaced and the millimeter amounts. In particular I was looking for whether or not the ANS was to be moved FORWARD in addition to the rotation or with the rotation. It is because you conveyed that there would be forward advancement of the ANS:
......the Dr. I consulted with said he wouldn't do any advancement on the upper jaw, only rotation, which would result in an "advancement" of the ANS by about 2mm.....
There was NO actual directional displacement plan read out. But it looked like the rotation was a FAVORABLE one which corrected the relationship between the ANS and the upper lip as to REDUCE the overly obtuse nose base to upper lip angle. That is to say the CCW-r will improve the relationship between the ANS and the upper lip.
The advancement to the lower jaw (including the chin) is significant. The chin is advanced and also elongated via a CW rotation of the chin; a type of genio that elongates the chin in addition to advancing it.
The doctor has provided AMPLE VISUAL INFORMATION, for example a side by side look at the profile CONTOUR CHANGES for the profile and 3D type soft tissue model visuals for you to look at the changes to determine yourself whether you like those changes. In that regard, an actual directional displacement read out isn't really needed (by you) to visually compare the proposed changes in SELF DETERMINATION whether or not they are to your liking. They are AMPLE enough for you to do that. To my eye, they improve your profile contour and also the 3/4 view seen from the 3D type soft tissue model visuals.
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OK. I got to the new place you stored your files.
What I was looking for specifically was the PLAN READOUT which is a readout of all the areas displaced and the millimeter amounts. In particular I was looking for whether or not the ANS was to be moved FORWARD in addition to the rotation or with the rotation. It is because you conveyed that there would be forward advancement of the ANS:
There was NO actual directional displacement plan read out. But it looked like the rotation was a FAVORABLE one which corrected the relationship between the ANS and the upper lip as to REDUCE the overly obtuse nose base to upper lip angle. That is to say the CCW-r will improve the relationship between the ANS and the upper lip.
The advancement to the lower jaw (including the chin) is significant. The chin is advanced and also elongated via a CW rotation of the chin; a type of genio that elongates the chin in addition to advancing it.
The doctor has provided AMPLE VISUAL INFORMATION, for example a side by side look at the profile CONTOUR CHANGES for the profile and 3D type soft tissue model visuals for you to look at the changes to determine yourself whether you like those changes. In that regard, an actual directional displacement read out isn't really needed (by you) to visually compare the proposed changes in SELF DETERMINATION whether or not they are to your liking. They are AMPLE enough for you to do that. To my eye, they improve your profile contour and also the 3/4 view seen from the 3D type soft tissue model visuals.
I see. Regarding the ANS movement stuff, the Dr. explained to me that his plan is to only rotate the maxilla by 7 degrees ccw. But he said that this rotation would result in a small advancement of 2mm for the ANS. Meaning the ANS isn't the exact rotation point..
Should I ask the Dr. for the exact movement table? I remember him showing it but he didnt share it with me. I feel like visuals go over numbers in this case, like you already mentioned.
The rough movements I managed to memorize were: Maxilla 7 degrees ccwr resulting in 2mm advancement of the ANS, BSSO 8mm, genioplasty 6mm, ramus widening 4mm on one side and 5mm on the other.
Two more questions:
-Do you think I would benefit from ramus widening? Straighter ramus viewed from the front and slightly increased gonial width? Or would it make my jaw too wide
-What do you think of my occlusion in the post OP pics. This plan is a surgery first/only approach since the Dr. said my occlusion is fine/stable and he wants to keep it. But I don't want to cut corners
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I see. Regarding the ANS movement stuff, the Dr. explained to me that his plan is to only rotate the maxilla by 7 degrees ccw. But he said that this rotation would result in a small advancement of 2mm for the ANS. Meaning the ANS isn't the exact rotation point..
Should I ask the Dr. for the exact movement table? I remember him showing it but he didnt share it with me. I feel like visuals go over numbers in this case, like you already mentioned.
The rough movements I managed to memorize were: Maxilla 7 degrees ccwr resulting in 2mm advancement of the ANS, BSSO 8mm, genioplasty 6mm, ramus widening 4mm on one side and 5mm on the other.
Two more questions:
-Do you think I would benefit from ramus widening? Straighter ramus viewed from the front and slightly increased gonial width? Or would it make my jaw too wide
-What do you think of my occlusion in the post OP pics. This plan is a surgery first/only approach since the Dr. said my occlusion is fine/stable and he wants to keep it. But I don't want to cut corners
That's the part that I found confusing when I looked at the ceph and started using geometrical observation to determine the rotation point. The ANS looked to be in the same place which is consistent with it being rotation point. Now on the (before) ceph, there was a RED DOT which was at or near a point called the 'A' point which is kind of behind the upper lip and below the ANS point. Now with CCW-r around the ANS point, the 'A' point (behind the soft tissue of lip) would go forward.
Both the ANS point and the A point are landmarks to the anterior maxilla which one sees on a ceph in profile view. The A point is displaced with CCW-r around the ANS point and the displacement of the A point (where the rotation is around the ANS point) can move the soft tissue of the upper lip forward.
Given that the overly OBTUSE angle formed by base of nose and upper lip was REDUCED by the rotation, (and that DID look GOOD), my GUESS is that he may have told you that part of the maxilla BELOW the ANS would move 2mm forward and something got lost in the translation.
The have advanced computer simulation programs that allow them to try different rotations and displacements as to get a prediction of the soft tissue response, bite, profile improvement etc. So, my guess is CCW-r around the A point kicked up a good profile contour.
None the less, the SALIENT thing is that it's an improvement.
Again, my MAIN aesthetic focus/concern here was with the ANS being unfavorably displaced with maxilla advancement. But the ceph (after) has ANS in same place but soft tissue of lips go forward to CLOSE IN on the OVERLY OBTUSE nose to lip angle and THAT makes you look better to the part I had aesthetic concerns over. So, that is SOLVED and not something you need to worry about.
Now the other things like ramus widening (increased gonial width) need to be things you SELF DETERMINE via the VISUALS he provided. The overall change looks GOOD to my eye and good occlusion is worked into the whole thing. But again, it's YOUR EYE that needs to like the proposed changes.
The exact displacement read-out is not needed at this point.
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That's the part that I found confusing when I looked at the ceph and started using geometrical observation to determine the rotation point. The ANS looked to be in the same place which is consistent with it being rotation point. Now on the (before) ceph, there was a RED DOT which was at or near a point called the 'A' point which is kind of behind the upper lip and below the ANS point. Now with CCW-r around the ANS point, the 'A' point (behind the soft tissue of lip) would go forward.
Both the ANS point and the A point are landmarks to the anterior maxilla which one sees on a ceph in profile view. The A point is displaced with CCW-r around the ANS point and the displacement of the A point (where the rotation is around the ANS point) can move the soft tissue of the upper lip forward.
Given that the overly OBTUSE angle formed by base of nose and upper lip was REDUCED by the rotation, (and that DID look GOOD), my GUESS is that he may have told you that part of the maxilla BELOW the ANS would move 2mm forward and something got lost in the translation.
The have advanced computer simulation programs that allow them to try different rotations and displacements as to get a prediction of the soft tissue response, bite, profile improvement etc. So, my guess is CCW-r around the A point kicked up a good profile contour.
None the less, the SALIENT thing is that it's an improvement.
Again, my MAIN aesthetic focus/concern here was with the ANS being unfavorably displaced with maxilla advancement. But the ceph (after) has ANS in same place but soft tissue of lips go forward to CLOSE IN on the OVERLY OBTUSE nose to lip angle and THAT makes you look better to the part I had aesthetic concerns over. So, that is SOLVED and not something you need to worry about.
Now the other things like ramus widening (increased gonial width) need to be things you SELF DETERMINE via the VISUALS he provided. The overall change looks GOOD to my eye and good occlusion is worked into the whole thing. But again, it's YOUR EYE that needs to like the proposed changes.
The exact displacement read-out is not needed at this point.
I see. Very reasuring that a knowledgable user agrees on the plan. And yea in the end it's not about exact measurements but about what looks good. I was asking about the occlusion because one surgeon (the one who also made the plan I showed) said I can/should do surgery first. However, another surgeon said that I need decompensation orthodontics before. Two world class surgeons contradicting each other really confused me..
Regarding ramus widening, I might try jaw fillers first to try if the general direction is the right one. Very hard to judge what impact an increased bigonial width would have on my face sadly.
By the way, would you say I might need MSE? Can provide pictures of my bite if necessary.
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I see. Very reasuring that a knowledgable user agrees on the plan. And yea in the end it's not about exact measurements but about what looks good. I was asking about the occlusion because one surgeon (the one who also made the plan I showed) said I can/should do surgery first. However, another surgeon said that I need decompensation orthodontics before. Two world class surgeons contradicting each other really confused me..
Regarding ramus widening, I might try jaw fillers first to try if the general direction is the right one. Very hard to judge what impact an increased bigonial width would have on my face sadly.
By the way, would you say I might need MSE? Can provide pictures of my bite if necessary.
Can't make a call on that. As for surgery first vs decompensation, you've gotta go with the PLAN if you like the PLAN. So, if the PLAN I looked at is also to your liking, you go with the way the doctor wants to conduct the ORTHO with it.
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in general, how about just cutting/shaving the ANS during LeFort? I mean it seems to be a very obvious and simple solution without having to do a additional rhino, no? just shave off 2,3,4mm, seems simple enough
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in general, how about just cutting/shaving the ANS during LeFort? I mean it seems to be a very obvious and simple solution without having to do a additional rhino, no? just shave off 2,3,4mm, seems simple enough
Sadly I've never seen any results of that procedure which makes it rather risky for me.