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Aesthetics / Re: Differences in potential outcomes between two surgical plans?
« Last post by kavan on May 08, 2024, 05:55:14 PM »
I appreciate the feedback Kavan. You're right it really isn't a plan it's a just a morph. If money wasn't a factor of course I'd go to G but that isn't a reality right now. I'll take your advice and go do some more shopping with G's plan. I tried to show G's plan to the local guy but he wouldn't even look at it. I described it and he was pretty dismissive of the extreme movements and clearly knew who G was and seemed slightly offended. Even if I have to wait a while longer or wait until I'm making real money, you only get one good shot at this thing so I shouldn't mess around.

Sounds like what I thought it was; morph is a combo of his aesthetic preferences and surgical limitations.
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I appreciate the feedback Kavan. You're right it really isn't a plan it's a just a morph. If money wasn't a factor of course I'd go to G but that isn't a reality right now. I'll take your advice and go do some more shopping with G's plan. I tried to show G's plan to the local guy but he wouldn't even look at it. I described it and he was pretty dismissive of the extreme movements and clearly knew who G was and seemed slightly offended. Even if I have to wait a while longer or wait until I'm making real money, you only get one good shot at this thing so I shouldn't mess around.
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Aesthetics / Re: Differences in potential outcomes between two surgical plans?
« Last post by kavan on May 08, 2024, 03:02:31 PM »
I have two relevant surgical plans I'm trying to compare. One is from G and the other is from a local surgeon with a lot of experience. I am independently weighing the cost differences, because of G's large costs, and the risks each surgeon could come with. I'd appreciate some help comparing the actual differences between the two plans I have.

G's plan- https://imgur.com/a/XzEZgYj
Multisegment lefort I, BSSO, and genioplasty (said about 9mm lefort and 15mm BSSO)

Local Surgeon- https://imgur.com/a/XXuqtjU
 lefort I,BSSO, (no genio or multisegment, although not because he doesn't do either just believes they are unnecessary)

The local surgeon's plan is a morph which I'm having trouble comparing to G's diagrams and visualizing myself. I think the morph looks good but have a few questions about comparing the two:

How accurate are morphs with experienced surgeons?
How different are the aesthetic and airway outcomes in both of these cases?
Ignoring risk, could I be leaving large aesthetic gains on the table by choosing the local surgeon based on these plans?

I'd also welcome any general discussion or comments on the plans themselves. Appreciate anyone taking the time to respond.

Firstly, you are not comparing 2 'plans'.
The local guy just gives you a morph. Gunson gives you an actual PLAN with a read-out of the displacements.
Gunson's plan gives you a better balanced profile than the local doctor's morph. Local guy shows improvement to your profile but less lower jaw projection than Gunson's. So, depends on whether or not you want more lower jaw projection than your local guy shows in his morph vision. It also depends on if your local guy can achieve the 'vision' he shows on the morph in the absence of DISPLACEMENT DATA that conforms to the morph.

I should also note that JUST a morph just shows the local guys 'vision' for you which can be combination of his preferred aesthetics and also his limitations to do more complex or involved surgical maneuvers. For it to be an actual surgical PLAN, it would need to come with all the DISPLACEMENTS in many areas that you see in Gunson's plan. I can't make a comparison between an actual PLAN and some morph that is absent of any 'plan'. Again, plans come with displacement readouts. So, in the absence of that, I hesitate to call your local guy's morph a 'plan'. However, if I were you, I'd ask the guy for his displacement readouts for that morph. Why? Because neither you nor I would know how accurate his morph was in the ABSENCE of a displacement readout that listed all the many displacements needed to achieve the 'vision' of the morph.

So, let's say your local guy's morph is something he can pull off on the operating table in the absence of charting out all the varied specific displacements that would achieve his vision for you. IF he can, then you would have an improvement for LESS cost than Gunson. It could work IF you also wanted LESS jaw advancement than Gunson shows in his contour diagram. Gunson's  displacement read out lists all the varied displacements that CONFORM to his contour diagram. Your local guy doesn't do that.

In closing, I'd say your local guy's morph shows an improvement. But Gunson's contour diagram shows a better profile contour than your local guy's 'vision' for you. So, if improvement is a whole lot LESS $$$ than a better profile contour that Gunson shows (and with excessive costs), then go for the potential improvement the local guy offers. Also, ask yourself that IF money was not an object and both costs were the same, WHICH doctor would you go to; some local guy or Gunson?

ETA: Sometimes a local guy can do what Gunson does IF they have an actual displacement proposal PLAN that Gunson provides. So, it is possible to take Gunson's plan around to other doctors who might be able to do similar at lower price. However this is not the case here since your local guy said he would be doing things differently.

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Aesthetics / Re: What kind of surgery was used here
« Last post by kavan on May 08, 2024, 02:00:33 PM »
Where the graft was used ? Isn't graft used only in CCW ? Why would a CW need a graft ? Also do you think the same method could be used on someone with relative normal upper teeth show ?

My prior statement conveyed where an OVERALL maxillary graft would be used which means spanning the entire maxilla with purpose of vertically elongating the entire maxilla. That is HOW the lower 1/3rd of face gets LONGER and gets more upper tooth show on a person with a vertically short maxilla who has little to no upper tooth show.

NO. Grafts are not 'only used' in CCW. If that were the case, then 'only' people needing a CCW graft could get a graft and people needing a CW graft couldn't get any. Your question of: 'Why would a CW need a graft ?' assumes that 'only' people needing a CCW graft are candidates for any grafts and you ask after I explained the type of graft the person had. Let me put it this way: If the person in the photo who started with lack of upper tooth show and short lower 1/3rd ended up with a longer lower 1/3rd and more tooth show didn't have the the graft I told you she had, she wouldn't have had the improvement seen in the after.

Different types of grafts for different needs:

ISOLATED:
a: Posterior downgraft ISOLATED to posterior maxilla = CCW posterior downgraft
b: Anterior downgraft ISOLATED to anterior maxilla= CW anterior downgraft.

OVERALL DOWNGRAFTS:

Overall downgrafts span the entire maxilla to elongate the maxilla.
Candidates= people who have a short lower 1/3rd because of a short maxilla and also who have LACK up upper tooth show.

Rotation of Overall downgrafts:

If the anterior part of downgraft is longer than the posterior part, the NET rotation is NET CW

If the posterior part of the downgraft is longer than the anterior part, the NET rotation is NET CCW.

If the downgraft to the overall maxilla is uniform throughout, then there is no NET rotation.

QUIZ for you:

1: Are grafts 'only' uses in CCW? Yes____. No___

2: What type of graft did the person in the photo (who ended up with a longer lower 1/3rd and more tooth show) most likely get?

a: an isolated CW anterior downgraft
b: an isolated CCW posterior downgraft
c: an overall downgraft to elongate maxilla with NET CW-r
d: an overall downgraft to elongate maxilla with a NET CCW-r

3: As to the question of: CAN the 'same method could be used on someone with relative normal upper teeth show ? Let's see if you can answer that yourself now that I gave you the basic relationships.

Would an overall downgraft to elongate the lower 1/3rd (whether or not it's net CW or net CCW rotation) that INCREASES upper tooth show be a method to use in a person who had normal upper teeth show and didn't need any extra upper teeth show?  Yes____. No____.

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Aesthetics / Re: What kind of surgery was used here
« Last post by Freddie54 on May 08, 2024, 08:41:10 AM »
Her lower 1/3 of her face is longer in the after, she starts with little upper tooth show and maxillary recession. So, most likely an overall graft to the maxilla with net CW-r in addition to maxillary and mandible advancement.



Where the graft was used ? Isn't graft used only in CCW ? Why would a CW need a graft ? Also do you think the same method could be used on someone with relative normal upper teeth show ?
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Aesthetics / Differences in potential outcomes between two surgical plans?
« Last post by midwest_sl8 on May 07, 2024, 07:46:26 PM »
I have two relevant surgical plans I'm trying to compare. One is from G and the other is from a local surgeon with a lot of experience. I am independently weighing the cost differences, because of G's large costs, and the risks each surgeon could come with. I'd appreciate some help comparing the actual differences between the two plans I have.

G's plan- https://imgur.com/a/XzEZgYj
Multisegment lefort I, BSSO, and genioplasty (said about 9mm lefort and 15mm BSSO)

Local Surgeon- https://imgur.com/a/XXuqtjU
 lefort I,BSSO, (no genio or multisegment, although not because he doesn't do either just believes they are unnecessary)

The local surgeon's plan is a morph which I'm having trouble comparing to G's diagrams and visualizing myself. I think the morph looks good but have a few questions about comparing the two:

How accurate are morphs with experienced surgeons?
How different are the aesthetic and airway outcomes in both of these cases?
Ignoring risk, could I be leaving large aesthetic gains on the table by choosing the local surgeon based on these plans?

I'd also welcome any general discussion or comments on the plans themselves. Appreciate anyone taking the time to respond.

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Aesthetics / Re: What kind of surgery was used here
« Last post by kavan on May 07, 2024, 02:40:22 PM »
Her lower 1/3 of her face is longer in the after, she starts with little upper tooth show and maxillary recession. So, most likely an overall graft to the maxilla with net CW-r in addition to maxillary and mandible advancement.

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Aesthetics / What kind of surgery was used here
« Last post by Freddie54 on May 07, 2024, 10:35:05 AM »
I came across this result from a retired french surgeon on youtube and was blown away from the result does anyone knows what kind of surgical procedure was operated on the women here ?


Looks like Clockwise rotation to me but I’m not sure, here’s the video if you wanna check there’s subtitles the patient case is around 13:00 https://youtu.be/JlR_-sOcZPM?si=Nr1VyTfnN5P9orL2

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Aesthetics / Re: I'm very nervous for my upcoming revision
« Last post by mediumdrinkofwater on May 06, 2024, 09:47:32 AM »
How big were the movements for upper and lower jaw in the first surgery? How many mm shall the upper jaw be brought back in the revision?
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Aesthetics / Re: I'm very nervous for my upcoming revision
« Last post by Kadath on May 05, 2024, 07:14:47 PM »
Any thoughts?
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