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General Category => Aesthetics => Topic started by: ProsfeR on July 14, 2018, 09:48:02 AM

Title: Any Suggestions?
Post by: ProsfeR on July 14, 2018, 09:48:02 AM
Hello everyone!
What can I do to fix my face? x-ray is old from 2015 before braces. I had braces for almost 2 years, but I knew it wouldn't fix anything. Lip incompetence, gummy smile, nonexistent jawline and small chin.I just wanna look normal. I've been on consultation with local surgeon and he said I need counterclockwise rotation. What do you guys think?
Title: Re: Any Suggestions?
Post by: haven on July 14, 2018, 10:30:00 AM
Your head's position in both pictures don't look to be the same and in the xray it looks like they positioned you to look downward? Which might exaggerate your reccession.  Granted I'm a layman so someone with more experienced might be able to chime in on that.
Title: Re: Any Suggestions?
Post by: sanddunes on July 15, 2018, 08:14:20 PM
Your lower jaw and chin are both severely recessed.  Bi-max surgery and genioplasty will help you greatly!  You could also use rhinoplasty.
Title: Re: Any Suggestions?
Post by: sanddunes on July 15, 2018, 08:26:18 PM
Did a quick morph for you (others here are better at morphs than me, but I'm just trying to give you a general idea)
Title: Re: Any Suggestions?
Post by: sanddunes on July 15, 2018, 08:41:38 PM
It looks like you have a thin upper lip - when the upper jaw comes forward your upper lip will become fuller and look beetter - I'm not able to show that on the morph though
Title: Re: Any Suggestions?
Post by: ProsfeR on December 15, 2018, 01:38:03 PM
I do have a thin upper lip and very thick lower lip. I also have an open mouth posture and I really hope surgery can fix this but I'm not sure how.
Title: Re: Any Suggestions?
Post by: ProsfeR on December 15, 2018, 01:41:17 PM
I have same problem as this girl maybe even worse
Title: Re: Any Suggestions?
Post by: korvitz on December 15, 2018, 06:46:04 PM
Ask your surgeon if he means CCW with ONLY anterior impaction or anterior impaction & posterior downgrafting.

If he says the latter (meaning this surgeon is capable of doing CCW with posterior downgrafting) ask him to show some of his cases where CCW with posterior downgrafting is involved.
Also ask him what material he uses for the downgraft.

Do you mouthbreathe when you fall asleep or have TMJ problems?

Also check out this thread

https://jawsurgeryforums.com/index.php?topic=7398.0
Title: Re: Any Suggestions?
Post by: ghiggson90 on December 15, 2018, 08:19:22 PM
IMO:

1) You have a relatively steep occlusal plane of around 20 degrees and a convex profile. Counterclockwise rotation by way of some combination of modest anterior maxillary impaction and posterior maxillary downgraft would address your concerns, improving facial balance, increasing the projection of the lower third of your face, decreasing gingival exposure. Remember it is better to under-correct in the vertical dimension.

2) You seem to have somewhat of a narrow airway, so advancement of the maxilla and mandible may help improve respiratory function as well.

3) A modest genioplasty would also increase projection of the lower third, decrease submental soft tissue excess, provide a more aesthetic mentolabial fold.
Title: Re: Any Suggestions?
Post by: ProsfeR on December 16, 2018, 01:52:38 AM
I don't have TMJ problems but I definitely mouthbreathe when I sleep.
Title: Re: Any Suggestions?
Post by: ProsfeR on December 16, 2018, 02:06:53 AM
Also my lower jaw is quite asymmetrical
Title: Re: Any Suggestions?
Post by: kavan on December 16, 2018, 08:35:15 AM
Yes. You would need CCW

Least advancement at base of the nose and most advancement to lower jaw and chin.   CCW with posterior downgraft to correct highly convex profile without exaggerating already prominent maxilla/nose area would most likely need to be included in the plan.

Plan could also possibly include cutting the maxilla into separate pieces (multi-segmented lefort 1) if that were needed for further adjustments.
Title: Re: Any Suggestions?
Post by: Dogmatix on December 16, 2018, 09:05:46 AM
Did a quick morph for you (others here are better at morphs than me, but I'm just trying to give you a general idea)

Think that looks way overdone, did another test what it could look like.
Title: Re: Any Suggestions?
Post by: ProsfeR on December 19, 2018, 12:08:15 PM
Guys can you look at this girl's surgery results? Do you think it was successful? I'm asking because she's from my country and surgery is cheap here but not sure about results. I think her profile is too strong now and her lower jaw looks little asymmetrical. https://www.youtube.com/watch?v=9gXCldPGExI&t=78s Would appreciate if you could take a look.
Title: Re: Any Suggestions?
Post by: ghiggson90 on December 19, 2018, 01:02:48 PM
Guys can you look at this girl's surgery results? Do you think it was successful? I'm asking because she's from my country and surgery is cheap here but not sure about results. I think her profile is too strong now and her lower jaw looks little asymmetrical. https://www.youtube.com/watch?v=9gXCldPGExI&t=78s Would appreciate if you could take a look.

Her chin is a bit strong, but overall I would say she has very good facial balance.
Title: Re: Any Suggestions?
Post by: ODog on December 21, 2018, 09:21:34 PM
Think that looks way overdone, did another test what it could look like.

Is this achievable? How many mm of advancement would effect this change do you think ?
Title: Re: Any Suggestions?
Post by: Dogmatix on December 22, 2018, 12:28:50 AM
Is this achievable? How many mm of advancement would effect this change do you think ?

I have no idea on both. What is achievable have to be answered by a surgeon. Everything is possible in photo edit where you don't have to consider anything. On the amount of mm, your guess is as good as mine, I don't have any way of measuring such.
Title: Re: Any Suggestions?
Post by: ODog on December 22, 2018, 04:20:57 PM
I’m going to guess it can be done beccause we have seen plenty of examples of substantial transformations on this board.
Title: Re: Any Suggestions?
Post by: jusken on December 22, 2018, 06:58:46 PM
While your chin is clearly too recessed, too much advancement will look out of balance with your forehead.  Careful with this!

In order to get the ideal amount of advancement, your forehead would also have to move forward (magically - sorry, there isn't a good solution to this). 

Attached is the ideal balance imo, but I would advise against against this kind of advancement otherwise...

Title: Re: Any Suggestions?
Post by: ProsfeR on December 23, 2018, 12:39:04 AM
While your chin is clearly too recessed, too much advancement will look out of balance with your forehead.  Careful with this!
In order to get the ideal amount of advancement, your forehead would also have to move forward (magically - sorry, there isn't a good solution to this). 

Attached is the ideal balance imo, but I would advise against against this kind of advancement otherwise...

Thank you I really don't care about ideal I want my mouth to close to be able to breathe througth my nose and to just look normal u know. It sucks that I have such a weak brow ridge.
Title: Re: Any Suggestions?
Post by: ProsfeR on December 23, 2018, 01:04:01 AM
While your chin is clearly too recessed, too much advancement will look out of balance with your forehead.  Careful with this!

In order to get the ideal amount of advancement, your forehead would also have to move forward (magically - sorry, there isn't a good solution to this). 

Attached is the ideal balance imo, but I would advise against against this kind of advancement otherwise...

Interested what you think about this case. Too much advancement?
Title: Re: Any Suggestions?
Post by: Dogmatix on December 23, 2018, 01:42:41 AM
Interested what you think about this case. Too much advancement?

Looks good to me.
Title: Re: Any Suggestions?
Post by: jusken on December 23, 2018, 02:39:35 PM
Interested what you think about this case. Too much advancement?

Given this case, with a retruded maxilla, it's probably a fine outcome.  His lower jaw in the after has a very aggressive balance now and his nose is slightly upturned and compacted. 

I can't see all the variables in your case, I'm just one of the more conservative people on here.  Your upper lip position is already at a good position relative to your other features.  I just want to caution you to not overdo it.

I've attached what I think would be the right balance for your forehead.


Title: Re: Any Suggestions?
Post by: ProsfeR on December 24, 2018, 06:49:44 AM
Given this case, with a retruded maxilla, it's probably a fine outcome.  His lower jaw in the after has a very aggressive balance now and his nose is slightly upturned and compacted. 

I can't see all the variables in your case, I'm just one of the more conservative people on here.  Your upper lip position is already at a good position relative to your other features.  I just want to caution you to not overdo it.

I've attached what I think would be the right balance for your forehead.

Thank you. Good morph,looks so realistic, gives me hope. It's crazy how important chin is for well balanced face.
Title: Re: Any Suggestions?
Post by: ProsfeR on December 25, 2018, 11:19:17 AM
Could someone explain to me what posterior maxillary downgraft actually means? Thank you
Title: Re: Any Suggestions?
Post by: Dogmatix on December 25, 2018, 01:00:39 PM
Could someone explain to me what posterior maxillary downgraft actually means? Thank you

It means bringing the landmark PNS of the maxilla vertically down.
https://www.researchgate.net/profile/Johan_Jansma/publication/264936795/figure/fig1/AS:608686481346560@1522133574245/Cephalometric-landmarks-and-reference-lines-traced-on-lateral-cephalograms-The-following.png
Title: Re: Any Suggestions?
Post by: ProsfeR on December 25, 2018, 01:21:22 PM
It means bringing the landmark PNS of the maxilla vertically down.
https://www.researchgate.net/profile/Johan_Jansma/publication/264936795/figure/fig1/AS:608686481346560@1522133574245/Cephalometric-landmarks-and-reference-lines-traced-on-lateral-cephalograms-The-following.png

So is CCW possible without posterior downgraft? If yes what difference would it make?
Title: Re: Any Suggestions?
Post by: Dogmatix on December 25, 2018, 01:27:56 PM
So is CCW possible without posterior downgraft? If yes what difference would it make?

Yes, it would mean to bring ANS vertically up by anterior impaction instead.
Title: Re: Any Suggestions?
Post by: ProsfeR on December 25, 2018, 01:35:56 PM
Yes, it would mean to bring ANS vertically up instead.

Thank you. I mean the difference in results? For example in my case?
Title: Re: Any Suggestions?
Post by: Dogmatix on December 25, 2018, 01:43:03 PM
Thank you. I mean the difference in results? For example in my case?

Anterior impaction means moving ANS vertically up, which is  desired in cases with e.g gummy smile. Moving ANS up will decrease the teeth and gum show when smiling, why posterior down grafting or a combination may be preferred if such change is not desired.
Title: Re: Any Suggestions?
Post by: ProsfeR on December 29, 2018, 01:53:34 PM
Also I think my face looks kinda short. I have a big forehead. Do you guys think I would benefit from down genio or just forward genio? SARPE?
Title: Re: Any Suggestions?
Post by: kavan on December 29, 2018, 02:32:11 PM
Also I think my face looks kinda short. I have a big forehead. Do you guys think I would benefit from down genio or just forward genio? SARPE?

The genio usually depends on what they can do to the lower jaw.  The chin definitely needs forward advancement. But I would hold off actually asking for a downward drop with that (which would take a bone buttress or a graft to actually make the chin LONGER in addition to advancing) and just WAIT until the maxfax shares his plan with you which is usually in form of profile contour change diagram.
Title: Re: Any Suggestions?
Post by: dvfan on January 01, 2019, 04:55:06 AM
Hello everyone!
What can I do to fix my face? x-ray is old from 2015 before braces. I had braces for almost 2 years, but I knew it wouldn't fix anything. Lip incompetence, gummy smile, nonexistent jawline and small chin.I just wanna look normal. I've been on consultation with local surgeon and he said I need counterclockwise rotation. What do you guys think?

Agree with the CWW with posterior downgraft advice. Kavan gave you some very good advice in addition.

Dunno if you're interested in other aesthetic comments, but in the side view your superior lateral browbones seem recessed too making your lateral brows look droopy. It affects your orbital area and takes away from a masculine look. My point of view anyhow. Not too easy to fix though and most maxillofacial surgeons seem to ignore the orbital area. Imo it means they don't look at the entire picture.
Title: Re: Any Suggestions?
Post by: ProsfeR on January 01, 2019, 05:01:26 AM
Agree with the CWW with posterior downgraft advice. Kavan gave you some very good advice in addition.

Dunno if you're interested in other aesthetic comments, but in the side view your superior lateral browbones seem recessed too making your lateral brows look droopy. It affects your orbital area and takes away from a masculine look. My point of view anyhow. Not too easy to fix though and most maxillofacial surgeons seem to ignore the orbital area. Imo it means they don't look at the entire picture.

So how to fix it anyway?
Title: Re: Any Suggestions?
Post by: ProsfeR on February 05, 2019, 04:15:55 AM
Did a new ceph today with a normal head position(compared to my old ceph, they also confirmed is was wrong) and it looks different and I don't see how to advance my lower jaw it is almost already in line with my forehead. Could you guys take a look?
https://imgur.com/aEecFRl
Title: Re: Any Suggestions?
Post by: Dogmatix on February 05, 2019, 05:49:06 AM
Did a new ceph today with a normal head position(compared to my old ceph, they also confirmed is was wrong) and it looks different and I don't see how to advance my lower jaw it is almost already in line with my forehead. Could you guys take a look?
https://imgur.com/aEecFRl

I think normally the ceph tracements are normalized to FH-plane when doing the 2-d planning, which would rotate your picture clockwise and set your chin behind the forehead more.

Just to give you an idea of how it would work below.

https://imgur.com/a/DUCaRTP
Title: Re: Any Suggestions?
Post by: kavan on February 05, 2019, 02:26:14 PM
Did a new ceph today with a normal head position(compared to my old ceph, they also confirmed is was wrong) and it looks different and I don't see how to advance my lower jaw it is almost already in line with my forehead. Could you guys take a look?
https://imgur.com/aEecFRl

First  ceph with head tilted down, shows jaw retrusion and chin recession with what looks to be a small airway. It is consistent with the suggestion for CCW and chin advance.

Second ceph with head more upright, shows jaw retrusion and chin recession with what looks to be a small airway. It is also consistent with the suggestion for CCW and chin advance.


Conclusion: Both cephs show jaw retrusion and chin recession with what looks to be a small airway. Both cephs are consistent with suggestion for CCW and chin advance to address what bothers you, ("Lip incompetence, gummy smile, nonexistent jawline and small chin.").
Title: Re: Any Suggestions?
Post by: ProsfeR on February 05, 2019, 03:29:33 PM
First  ceph with head tilted down, shows jaw retrusion and chin recession with what looks to be a small airway. It is consistent with the suggestion for CCW and chin advance.

Second ceph with head more upright, shows jaw retrusion and chin recession with what looks to be a small airway. It is also consistent with the suggestion for CCW and chin advance.


Conclusion: Both cephs show jaw retrusion and chin recession with what looks to be a small airway. Both cephs are consistent with suggestion for CCW and chin advance to address what bothers you, ("Lip incompetence, gummy smile, nonexistent jawline and small chin.").

Thank you! Much appreciated.
Title: Re: Any Suggestions?
Post by: ProsfeR on March 02, 2019, 01:30:16 PM
A lil update. My ortho (who works with my surgeon) said she counted everything and it will be CCW as we discussed with her earlier. +-1 year in braces, then surgery. BUT she said it will be only anterior impaction without posterior downgrafting. (Gap will close itself?) Dunno if it is enough rotation? +Some maxillary advancement. Tbh I don't know what to do. I'm 25. I live in a third world country. Not so many options here. My surgeon is like the best in our country. Should I go for it or look for another surgeon? Thx
Title: Re: Any Suggestions?
Post by: ben from UK on March 02, 2019, 01:51:30 PM
Should have been something like this I guess?

Besides jaw- and chinwork this could maybe be achieved with browridge implant + lowering hairline + nosejob + forehead shave. Jaw + chin if done well will bring you up though.
Title: Re: Any Suggestions?
Post by: kavan on March 02, 2019, 02:21:26 PM
That might be sufficient to address the gummy smile and for some auto rotation of the lower jaw and allow you to get genio with it.
Title: Re: Any Suggestions?
Post by: ProsfeR on May 21, 2019, 11:20:41 AM
Kavan I am worried lefort advancement will make me look worse as I already have  prominent anterior nasal spine. My upper lip would protrude even more. Can max fax do anything about it or is it rhino work?
Title: Re: Any Suggestions?
Post by: Post bimax on May 21, 2019, 11:35:45 AM
Kavan I am worried lefort advancement will make me look worse as I already have  prominent anterior nasal spine. My upper lip would protrude even more. Can max fax do anything about it or is it rhino work?

How many millimeters of LF1 advancement?
Title: Re: Any Suggestions?
Post by: jusken on May 21, 2019, 11:49:28 AM
Should have been something like this I guess?

Besides jaw- and chinwork this could maybe be achieved with browridge implant + lowering hairline + nosejob + forehead shave. Jaw + chin if done well will bring you up though.

I'll probably be downvoted for this but, with all due respect, that morph looks like a freakshow.  I would suggest more the opposite of this, as few procedures as possible to bring lower third into a more favorable place.  No disrespect intended...

Prosfer: some amount of CCW + advancement would probably not cause much (if any) disruption to your nose.
Title: Re: Any Suggestions?
Post by: Post bimax on May 21, 2019, 12:04:12 PM
I'll probably be downvoted for this but, with all due respect, that morph looks like a freakshow.  I would suggest more the opposite of this, as few procedures as possible to bring lower third into a more favorable place.  No disrespect intended...

Prosfer: some amount of CCW + advancement would probably not cause much (if any) disruption to your nose.

The distance between the lower lip and pogonion in that morph is extreme so I think that's what's causing the odd look. I think the rhino is an improvement though. Your morph on pg 2 plus the rhino and slightly more chin projection would be ideal IMO.
Title: Re: Any Suggestions?
Post by: kavan on May 21, 2019, 01:42:06 PM
Kavan I am worried lefort advancement will make me look worse as I already have  prominent anterior nasal spine. My upper lip would protrude even more. Can max fax do anything about it or is it rhino work?

CCW rotation via anterior impaction:


You will get some CCW auto-rotation of the mandible with the CCW anterior impaction of the maxilla which will put your mandible in a better position. = 1 good thing which is almost CERTAIN

You will reduce your gummy smile with same CCW anterior impaction of maxilla. = 1 good thing which is almost CERTAIN.

Advancement of the maxilla:

Advancement of the maxilla should allow MORE advancement of the mandible. = 1 good thing which is almost CERTAIN.

Advancement of the maxilla in order to kick up the good thing of more advancement of the mandible could possibly result in unfavorable changes to the base of the nose which includes the top of the upper lip area. = 1 bad thing that is possible but highly UNCERTAIN.

NOTE: It's highly uncertain that maxillary advancement would be a 'bad' thing for you BECAUSE there is NO INFORMATION as to 'how much' advancement there will be there. That's DIFFERENT from the the mandible advancement because even if if HOW MUCH is unknown, we know, with certainty, that even a modest advancement to the mandible would be an improvement.


---------

Tally:

3 good things that are pretty certain VS 1 bad possible bad thing (a 'trade-off) that's uncertain.

IF the bad thing were certain, then 3 certain good thing vs 1 certain bad thing would mean a 75% 'pay-off' or over all improvement.

But since the bad thing you are worried about is UNCERTAIN, the potential 'pay-off' or IMPROVEMENT is MORE than 75%.

A 75% potential for over all improvement is pretty good and since the bad thing is uncertain, the potential for over all improvement gets higher.

Highly IRRATIONAL to think that something that could possibly happen (an unwanted aesthetic trade-off from maxillary advancement) would make you look worse in a circumstance where the maxillary advancement might be needed for an overall 75% improvement in your appearance.

Although the bad thing is NOT certain, IF it's something that you would not want to risk possibly happening IN EXCHANGE for a 75% over-all improvement, then don't get the surgery. Stay as you are.

There are no 100% certainties in these surgeries. So don't expect it to be 100% certain that you will be 100% improved. Learn to accept uncertainty and work with the ODDS or at least enough to know they are in your favor.

Title: Re: Any Suggestions?
Post by: ProsfeR on March 14, 2023, 11:24:17 PM
Hello everyone! It's been a while. I had jaw surgery yesterday.
As far as I know the maxilla was impacted  and advanced and the lower jaw was advanced 10mm + genioplasty 2.4mm. I'm so swollen. Breathing through the nose is so much better now.
Title: Re: Any Suggestions?
Post by: Tomasjohn on March 15, 2023, 11:17:59 AM
Recover well and fast. Keep us posted.
Title: Re: Any Suggestions?
Post by: ProsfeR on April 18, 2023, 06:50:04 AM
So, it's been a month since the surgery. Overall, I'm satisfied with the result even though it's still too early to tell. My mouth closure is still very forced. The lower lip is now so much smaller, but it still doesn't move much, and there's not much feeling compared to the upper lip which has almost recovered. The nose got a little wider, but not much.
Title: Re: Any Suggestions?
Post by: GJ on April 18, 2023, 01:27:30 PM
Great result from the side.
Title: Re: Any Suggestions?
Post by: kavan on April 18, 2023, 02:59:13 PM
That looks amazing. Can you share who the doctor was and where you got this done? I think lower jaw and chin nerves might take longer to heal.
Title: Re: Any Suggestions?
Post by: ProsfeR on April 19, 2023, 06:44:08 AM
Thanks!
I'm from Ukraine. The surgery was in Ukraine in Lviv. My surgeon is a good friend of Simonas Grybauskas from Vilnius, Lithuania. The surgery cost me over €6000. Here are more photos.
Title: Re: Any Suggestions?
Post by: Tomasjohn on April 19, 2023, 07:49:14 AM
Looks good.
Title: Re: Any Suggestions?
Post by: GJ on April 19, 2023, 01:14:42 PM
Yeah the nose widened quite a bit, but guys can get away with that. Still a great result overall.
Title: Re: Any Suggestions?
Post by: coldconduit on April 19, 2023, 02:03:53 PM
Congrats, you look really good. Your cheekbones look more defined too. How does your nasal breathing feel now, a month after?
Title: Re: Any Suggestions?
Post by: ProsfeR on April 20, 2023, 12:52:51 AM
Thanks! Nasal breathing is much better now, I immediately felt the difference right after the surgery.
Title: Re: Any Suggestions?
Post by: ProsfeR on May 16, 2023, 03:07:58 PM
2 months post-op. Lip closure is much better now.
Title: Re: Any Suggestions?
Post by: GJ on May 17, 2023, 08:26:32 AM
It's strange how your lower lip flattened out and widened like that. I wouldn't notice without seeing the before and after, so it's not a huge deal. Just something I have never seen and don't really understand why that would happen. It almost looks like the chin was widened? If so maybe that could cause it.
Title: Re: Any Suggestions?
Post by: ProsfeR on August 23, 2024, 06:55:57 AM
Hello, guys! It's been almost 1.5 yrs since my surgery. Thanks everyone for your help. The surgery was well worth it.
Title: Re: Any Suggestions?
Post by: Nitai_108 on November 28, 2024, 04:51:07 AM
Wow my friend the result looks great now after all the healing! The lower lip seems to have gained its fullness and shape again too. How is the numbness and sensation feeling? and would you mind sharing the name of your surgeon?