jawsurgeryforums.com
General Category => Functional Surgery Questions => Topic started by: timang on August 10, 2014, 08:50:17 AM
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I reckon most of us would like to have a defined V shaped lower third. I think it's very rarely achievable via BSSO but sometimes it results more pronounced bulky, U shaped lower third. What is the cause for that?
(http://www.jrgodontologia.com.br/timthumb-watermark.php?src=upload/Captura%20de%20tela%202011-07-27%20_s%2015.15.35.png&zc=1&w=800)
(http://www.jrgodontologia.com.br/timthumb-watermark.php?src=upload/Captura%20de%20tela%202011-07-27%20_s%2015.15.38.png&zc=1&w=800)
(http://www.jrgodontologia.com.br/timthumb-watermark.php?src=upload/Captura%20de%20tela%202011-07-27%20_s%2015.14.45_2.png&zc=1&w=800)
(http://www.jrgodontologia.com.br/timthumb-watermark.php?src=upload/Captura%20de%20tela%202011-07-27%20_s%2015.15.04.png&zc=1&w=800)
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@polynesian I think you're misunderstanding, he doesn't mean a tapered jaw, he means a defined jaw. You can have a tall ramus, and have a V-shape rather than U-shape in the chin area (in fact it's usually the case)
For these pics it's hard to say but it's going to depend on the shape of the existing bone structure and whether or not a genioplasty was done. Also, we have no idea where there is still swelling in these pictures
Also, people who have BSSO often have quite short ramii (??) which I think gives more of of a U shape and less definition. There is no bone in the back to stretch/support the tissue so it ends up in the prejowl area
Many people who need BSSO also need implants or a chin wing to get an "ideal" bone structure
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The second girl seemed to have an impaction which lead to her having a more U shaped jaw
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Wow the second girl looks completely different, nose , lips, jawline, and she probably had a genio too...
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Why does the second girl have less scleral show in the after photo?
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It looks like she is just looking up slightly more, but I may be wrong.
To me it looks like the lower lids have been lifted or have more support.
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I suspect this is primarily the result of poor rami length pre-op. As a result the large degree of rotation flattens the mandibular plane and makes it appear wider, then the advancement brings out the U shape more.
Hypothetically a chin wing can help as it can not only advance but also widen the jaw angles to offset this effect.
Since the only way to create a V-shape would be to make the anterior part of the mandible thinner via bone shaving (asians do this sometimes I believe), or to widen the posterior part (which is what a chin wing can do). This depends a lot on the already existing facial shape and deficiencies of course.
Edit: Think of it like an optical illusion. If the U-shaped jaw is rotated upwards posteriorly then it will look more v-shaped. Especially as it's recessed so less of the rear is coming through. Then with advancement more of the jaw's shape becomes apparent. Plus you now have more of the jaw widening earlier on in the front of the face due to advancement. If that makes any sense at all. this is not easy to explain. Makes sense in my mind however ;D
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Tiny and Disillusioned, where do you get all that info! ;D That sounds very sensible.
I added the patients' side profile pics too. Perhaps that gives a better impression of their bone structure.
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Can you do a chin wing in combination with BSSO?
Yes. You can do a chin wing only or a BSSO + chin wing.
Especially, could a chin wing entirely solve this issue?
Entirely is such a strong word that I have to say no.
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What i meant is:
can a chin wing create sharp mandibular angles and a decent v line?
This patient had a chin wing. See for yourself.
(http://www.progenica.de/forum/uploads/monthly_03_2011/post-4936-130132862773.jpg)
(http://www.progenica.de/forum/uploads/monthly_03_2011/post-4936-130132862758.jpg)
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It looks like his lower lip shape went from straight to curved or pointed in the middle which makes his mouth look smaller and less masculine. I know jaw and chin osteotomies can reduce the amount of vermilion that shows but why would the shape change like that?
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Certainly a solid improvement, however far from ideal.
Is this the best that can be achieved ?
No, but a result one should expect imho.
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It looks like he also had a maxillary advancement which changed his top lip. Maybe the chin wing caused his lower lipto kind of roll out.
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He looks better in the after pictures but it still looks like he needs some kind of jaw surgery.
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What i meant is:
can a chin wing create sharp mandibular angles and a decent v line?
It depends on what you're starting with. I definitely don't think it can take you from hidden, completely non-definite angles and a short ramus to big chunky modelesque angles - you need implants for that. It enhances what you have but there are limits
Also it will depend on body fat %
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The second girl is a great example of excesive CCW rotation. Before she had all the earmarks of long face syndrome and after she looks like she has mild short face syndrome. Meaning flat occlusal/mandibular plane, prominent chin, lip redundancy, etc. She's still pretty and in someways her features did improve i.e. lip posture/closure, chin shape, bite.
However had the doctor chose a more modest surgical plan, it would gave her a more feminine and ideal result. Ideal in the sense that her facial features would have been in a class 1 relationship, attractive AND more agreeable for aging because as she gets older, her lips will descend and go inward ("old person mouth") and her jaw/chin will appear more prominent.
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The second girl is a great example of excesive CCW rotation. Before she had all the earmarks of long face syndrome and after she looks like she has mild short face syndrome. Meaning flat occlusal/mandibular plane, prominent chin, lip redundancy, etc. She's still pretty and in someways her features did improve i.e. lip posture/closure, chin shape, bite.
However had the doctor chose a more modest surgical plan, it would gave her a more feminine and ideal result. Ideal in the sense that her facial features would have been in a class 1 relationship, attractive AND more agreeable for aging because as she gets older, her lips will descend and go inward ("old person mouth") and her jaw/chin will appear more prominent.
So close, yet so far... :(
(http://i.imgur.com/rRFCmZ8.png)
She looks a lot better without the box jaw either. Something she could definitely fix. Hard to tell if it's all her jaw and not her masseters adding to the effect.
(http://i.imgur.com/2kRTbL9.png)
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I think she definitely looks a lot better though.
God, I realize I blessed I am when it comes to the way I look. I mean im no model or anything, but I cant complain how I look. I jus look at that poor guy and just hope he's happy with his results. I need to stop being so hard on myself and after all my swelling is gone, I have to move on in life and stop worrying about the way I look.
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I think she definitely looks a lot better though.
God, I realize I blessed I am when it comes to the way I look. I mean im no model or anything, but I cant complain how I look. I jus look at that poor guy and just hope he's happy with his results. I need to stop being so hard on myself and after all my swelling is gone, I have to move on in life and stop worrying about the way I look.
after looking at many before and afters and reading a lot of text books that's how i've come to feel as well. many jaw surgery candidates look like they've bitten on a stick of dynamite and still look "off" after their surgery while even before surgery i look normal. all those one in a million results floating around online can really skew the perception on what's actually going on in reality. it's probably best to expect nothing and be glad if no complications arise after surgery.
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I suspect this is primarily the result of poor rami length pre-op. As a result the large degree of rotation flattens the mandibular plane and makes it appear wider, then the advancement brings out the U shape more.
Hypothetically a chin wing can help as it can not only advance but also widen the jaw angles to offset this effect.
Since the only way to create a V-shape would be to make the anterior part of the mandible thinner via bone shaving (asians do this sometimes I believe), or to widen the posterior part (which is what a chin wing can do). This depends a lot on the already existing facial shape and deficiencies of course.
Edit: Think of it like an optical illusion. If the U-shaped jaw is rotated upwards posteriorly then it will look more v-shaped. Especially as it's recessed so less of the rear is coming through. Then with advancement more of the jaw's shape becomes apparent. Plus you now have more of the jaw widening earlier on in the front of the face due to advancement. If that makes any sense at all. this is not easy to explain. Makes sense in my mind however ;D
^ this.
Pre-op I always sort of had a babyface look. I thought had a V-jaw with chubby cheeks. Now that my mandible has swung forward you see that it's more of a U shape. The V-shape was an optical illusion.
I think the chubby cheeks thing was also an illusion. They weren't really chubby but even when I smiled my lower jaw was far back enough that my cheeks looked huge in comparison.
For the record I don't think either photo represents the best surgeries I've ever seen, but both girls look better post-op than pre-op.
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Second girl's result would be A+ if she was a guy. Is it in general easier to get an aesthetic result for men?
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is it just me or does the first girl look kinda nice in her pre-op profile pic? ??? are recessive lower jaws more common amongst women or something because that pre-op mandible position does seem sort of feminine in profile.
how does the V vs U shape of the lower face play out when the bsso moves the lower jaw in the other direction - for a class 3 patient?
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is it just me or does the first girl look kinda nice in her pre-op profile pic? ??? are recessive lower jaws more common amongst women or something because that pre-op mandible position does seem sort of feminine in profile.
I don't know about more common, but a retruded profile is more culturally acceptable in females.
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I don't know about more common, but a retruded profile is more culturally acceptable in females.
maybe that's what i'm thinking of. is a retruded profile one where your jaws (lower face) sit behind a vertical line connecting certain facial landmarks - when viewed in profile? or is it just that, in profile, the front of your maxilla sits in a posterior position to the front of your forehead? im getting myself confused! :-\