jawsurgeryforums.com
General Category => Functional Surgery Questions => Topic started by: terry947 on January 14, 2015, 09:22:10 PM
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Here a link to my dropbox: (deleted)
After I got my braces off my dentist mentioned that I'd need jaw surgery to fix my open bite. From what I can tell my Maxilla is dropping and my chin/jaw is receding. I have bimaxillary protrusion and I dont even know where to start on that. Also ever since I took the time and learned about jaw surgery I've come to hate the way things sit on my face. My mid face is flat and just overall I feel self concious about it. My bi maxillary protrusion also makes my face look more " normal" but to me it looks bad.
I'd like honest answer and opinions on what would need to be done. I already spoke to a some people on here but I'd like some more opinions/recommendations.
Thanks! :)
Also I have the option of getting jaw surgery in Canada payed for by the government because I have tmd and sleep apnea, but I feel like the surgeries performed here wouldn't adress the mid face. So Id rather to save up some money and take the risk and get a modified lefort III. That way it addresses everything.
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I agree with Tumerican.
I had bimaxillary rotational advancement plus genioplasty in November and it cured my sleep apnoea as well as giving my lower face the correct proportions. (Pictures posted in the Overbites section)
I would definitely recommend finding a good maxillofacial surgeon.
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thanks guys. Honestly, do you guys notice a mid face deficiency or am i just self conscious?
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I think jaw surgery will really help you. You have good undereye support from your cheekbones
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I think a conventional double jaw surgery should be enough for you. Mid faces are tough to evaluate aesthetically even for trained surgeons. A Le Fort I advancement will take away the flat look, but it won't give you "plates of armour" right under your eyes. It will sort of "tent things up" and give your face more depth and make the orbital weakness less obvious. On the other hand, there is a chance of coming out looking a bit "chimpy". I would also consider a zygomatic osteotomy. Hard to give this advice given that I've only ever seen those "sandwich" ZOs done by MM, and the improvement looked marginal... but it should theoretically give you more facial width and take away the "long flat" look.
I know the Obwegesser demon->angel girl gives everyone the vapours, but I've only ever seen modified Le Fort III done on ridiculously recessed class IIIs with bulging eyes. OK, she did not have bulging eyes, but she was a pretty severe class III.
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Thanks for your input everyone. :D I will have a consultation with an old friends dad who is a top craniofacial surgeon and ask for him opinion. I'll also get a CT scan and ceph to see whats actually going on.
The only thing I'm worried about is the chimpy look because I have slight bimaxillary protrusion, and If they move everything forward, it'll make it stand out. Then again, everything pretty recessed as well and maybe it'll balance it out. Also I have a pretty big head, even though my face is long, it looks even longer because of the fat/skin under my neck due to no support from my jaw/chin (Updates some photos to show my holding back my neck fat :'( ). My brother has a fairly wide horizontal face and his is only less than 1 cm wider (measured with digital calipers).
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My brother has a fairly wide horizontal face and his is only less than 1 cm wider (measured with digital calipers).
Having read JSF and hearing about "normal" siblings, I am sort of relieved that I have no siblings at all. I can only imagine having a brother that got all the best features of my parents as opposed to me.
You do have pretty good eyes - the most important feature, and there is no surgery for potato eyes.
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I agree with Tumerican.
I had bimaxillary rotational advancement plus genioplasty in November and it cured my sleep apnoea as well as giving my lower face the correct proportions. (Pictures posted in the Overbites section)
I would definitely recommend finding a good maxillofacial surgeon.
I agree. You have the potential to look good but you need trimax because you have a very weak chin.
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My brother has a fairly wide horizontal face and his is only less than 1 cm wider (measured with digital calipers).
It's worth noting that 1cm is the difference between 50th percentile and 95th for bizygomatic breadth.
Pretty crazy.
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The difference between my brother and me is that he maintained tongue posture since childhood. I started mouth breathing around 5 years old, so I guess my face started to develop properly, then went down hill from there. Also when he was younger he would chew things all the time, I remember him chewing pens caps and stuff like that. Now he has a wide jaw, and shorter face. Probably 1-2 inches shorter. SUCKS ASS, but what are you gunna do about it..... thats life.
goes to show that our environment plays a huge role during our development years.
@ sean - trimax being lefort, bsso and genio?
And just to get this right Id need
1) Lefort 1 (not sure if it has to be high)
2)CCW rotation and forwards and up movement
3) Impaction
4)Bsso
5) Genioplasty.
seems like a lot no?
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And just to get this right Id need
1) Lefort 1 (not sure if it has to be high)
2)CCW rotation and forwards and up movement
3) Impaction
4)Bsso
5) Genioplasty.
seems like a lot no?
Pretty standard actually. A ZO would probably be worthwhile as well. Maybe chin wing instead of genio.
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@plosko - doesnt a ZO just make the face a little wider? It doesn't affect the eye area at all, from what I've read of this forum.
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@plosko - doesnt a ZO just make the face a little wider? It doesn't affect the eye area at all, from what I've read of this forum.
Selfies can be deceiving - my face looks long in them, but like a ball in other photos. That's why my surgeon refused a ZO or a lefort iii. But your face looks narrowish in your photos, so you may benefit. But it could be just lens distortion.
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@plosko - thanks. I'll look into it. I feel like if my lower jaw was only a litter wider and my mid face protruded more forward, I wouldnt look like I have a long face. I actually measured my face and its a little under 9" from hairline to bottom of chin.
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@plosko - thanks. I'll look into it. I feel like if my lower jaw was only a litter wider and my mid face protruded more forward, I wouldnt look like I have a long face. I actually measured my face and its a little under 9" from hairline to bottom of chin.
9 inches? Thats pretty crazy. You could really benefit a lot from CCW rotation with any of these surgeries, even the Lefort III. Were you a mouthbreather during childhood?
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@yxcvb - Ya I started mouth breathing around 5 years old. When I ask people if my face is long they say its proportionate to my body at the same time I have a pretty big head. My width is around 7inches. In 6'4" and 235 so I'm a pretty big dude. I measured my friends face who's realt good looking and he's length is a little under 8" but his maxilla is prominent.
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@yxcvb - Ya I started mouth breathing around 5 years old. When I ask people if my face is long they say its proportionate to my body. In 6'4" and 235 so I'm a pretty big dude. I measured my friends face who's realt good looking and he's length is a little under 8" but his maxilla is prominent.
Makes sense, you can always go by the 1/10th rule. My maxfac surgeon told me facial height should be between 1/9.5 to 1/10 of one's height, and thats what they can use in calculations besides facial thirds etc.
So if you're 76 inches tall 76/9.5 thats exactly 8 inches.
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Terry why you think that zygomatic sandwich osteotomy can't give you more cheek prominance in two directions ? Where did you read that ?
PS To be honest... I recommend lavement for all of us :)
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Hey Rico, I'm no expert and just just recently started to learn as much as I can about jaw surgery. That being said, when what I've read it seems like zygomatic sandwich would only widen the face. For eyes/cheek bones to change you'd have to physically move the maxilla forwards. Thats my opinion.
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Hey Rico, I'm no expert and just just recently started to learn as much as I can about jaw surgery. That being said, when what I've read it seems like zygomatic sandwich would only widen the face. For eyes/cheek bones to change you'd have to physically move the maxilla forwards. Thats my opinion.
I've seen before/after pictures of zygomatic osteotomies that resulted in more forward projection of the zygoma. I don't think that results in more attractive features though. This post pretty much sums up my thoughts about the zygomatic osteotomy: http://jawsurgeryforums.com/index.php/topic,857.msg16997.html#msg16997
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Full text about ZSO including before / after photos.
hmm I thought it looks little different
Terry now I see you mostly were right
it looks like ZSO is not good for malar reposition
https://www.researchgate.net/publication/8639801_Aesthetic_malar_recontouring_the_zygomatic_sandwich_osteotomy
click full text on the right
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I've seen before/after pictures of zygomatic osteotomies that resulted in more forward projection of the zygoma. I don't think that results in more attractive features though. This post pretty much sums up my thoughts about the zygomatic osteotomy: http://jawsurgeryforums.com/index.php/topic,857.msg16997.html#msg16997
so for me is useless...
When you want to mobilise whole zygomatic bone (in my case including part of maxillary bone) you have to cut like this:
(http://www.e-aps.org/ArticleImage/2023APS/aps-39-333-g001-l.jpg)
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Hey guys I got a ceph and a pan jaw x-ray. Any additional input is appreciated.
heres the dropbox link: https://www.dropbox.com/sh/9uc4vc0mv0fbz8t/AAAIqNyCh29Abp2pQO9UbBrda?dl=0
The orthodontist that I saw said I'd need a lefort I going downwards and forwards, which makes no sense to be. When I mentioned a cww rotation he totally dismissed it. On to the next I guess.
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I've seen before/after pictures of zygomatic osteotomies that resulted in more forward projection of the zygoma. I don't think that results in more attractive features though. This post pretty much sums up my thoughts about the zygomatic osteotomy: http://jawsurgeryforums.com/index.php/topic,857.msg16997.html#msg16997
Spot on.
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I know I'm repeating myself (I wrote about this on the 2 others threads about midface surgery), but check this : https://www.researchgate.net/publication/49646858_Zygomatic_sagittal_split_osteotomy_a_novel_and_simple_surgical_technique_for_use_in_midface_corrections
I do not know completely what it is.
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Hey, has anyone checked out my ceph?
@ Rico - the paper looks interesting.
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Makes sense, you can always go by the 1/10th rule. My maxfac surgeon told me facial height should be between 1/9.5 to 1/10 of one's height, and thats what they can use in calculations besides facial thirds etc.
So if you're 76 inches tall 76/9.5 thats exactly 8 inches.
Oh wow, good to know. My face is way too long for my height then :-\
ETA: Terry, I have a sibling too with more ideal facial proportions. It can be frustrating to see the differences, but it's nice to know surgery might help.
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Ya it sucks a lot. Learning about this stuff kind of opens your eyes to the amount of cranial dystrophy that has occurred. Jaw surgery is cool but the movements aren't that huge though. If you have a long face they can impact your maxilla by how much? 5mm max I think.
So the changes usually aren't that big.
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(http://i.imgur.com/NuMwGuP.jpg)
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Point A and B need to touch the red vertical line and your occlusal plane needs to be flatter.
so bimax CCW and probably a genio for your non existing chin.
[attachment deleted by admin]
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;D wow amazing notrain!!! thanks for this!
In your opinion, does my bimax protrusion look bad?
@ tumerican - ya thats what mouth breathing does to you.
I wondering if the midface recession is noticeable enough from ceph to the point where a surgeon could consider a high lefort I or a Lefort II/III...
heres pics of my face again incase people want to compare it with the ceph: https://www.dropbox.com/sh/kfmezx6sre5pfpe/AAChETm8p18dLyP6WCKukWZ3a?dl=0
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in my opinion, no.
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We're somewhat similar in ways. I also have a big brow ridge which supports the upper part of my eyes well, but my lower orbital rims are weak so I have some scleral show. You don't have that so you're lucky in that aspect. I think fixing your bimax will do a lot for your looks and health, it's just that some are reccomending a lot of surgeries so hopefully you can find what you're looking for without going the extremely invasive route(i.e. one and done).
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thats for the input guys. I don't have scleral show, but my eyes droop on the sides, I guess because of the dropped maxilla? When I have forward head posture it looks worse because I bring my chin upwards. In all of the picture+ceph, I kind of tuck my chin in and try to position my head as if it was level. If that makes sense.
f**k if only I didn't mouth breathe I think I would've have been an ok looking guy.
Also judging from the ceph does the mimax protrusion look dental or skeletal?
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Also would it be even possible for jaw surgery to line up point a & b with the redline? seems like its a pretty big movement. And from what I've read the maxilla can only be moved 7mm max, which seems small.
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your bimax protrusion is dental (small dental arches pushing the teeth labially).
arnett and gunson could line up points A and B with the red line, a run of the mill surgeon probably not.
there's a scale in the top right corner of your ceph, you can use this to measure your recession. a big step is 1cm, a small step 2mm.
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Oh I didn't even notice that scale. Thanks for the help notrain!
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Walk through your local mall, and you will see very tall people with tiny heads, short people with huge heads and everything in between. I wouldn't read too much into it. What is most important is how the features on the face sit together, their spacings.
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IMO, my head fits my bodysize well. My problem is my retruded jaws/chin make my face look longer then it actually is. The fat/skin under my chin has no where to go but down.
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IMO, my head fits my bodysize well. My problem is my retruded jaws/chin make my face look longer then it actually is. The fat/skin under my chin has no where to go but down.
I've said it before, but your problems are squarely at the occlusal level. You need conventional jaw surgery and everything else will fall into place.
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I really appreciate your advice Plosko, but I'll eventually try and get a consultation with A/G, keller, and hopefully obwegesser and see that they say. If it truly is at the occlusal level, I'd be very happy. :)
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Quick questions:
When getting BSSO, does it make the jaw also look wider? I've seen some before and after and it looks like it does.
Also when they impact the maxilla and make the occlusal more flat, would that make the mandible angle look less steep and the face look slightly shorter? Just wondering because when I jut my jaw forward, it makes my face look longer and more hollow looking...
(http://i.imgur.com/wUJhQVe.jpg?1)
my bite opened up because I wore a mouth guard at night that was angled at the front (stupid dentist) for grinding my teeth and also from tongue thrusting. I developed tongue thrusting sometime after braces, pre braces I was just a class 2 with a deep bite.
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Quick questions:
When getting BSSO, does it make the jaw also look wider? I've seen some before and after and it looks like it does.
yes, that's because the mandible is wider in the back than in the front. once you slide it forward, the wider part will be closer to someone looking at you.
Also when they impact the maxilla and make the occlusal more flat, would that make the mandible angle look less steep and the face look slightly shorter?
yes, that's how it works.