jawsurgeryforums.com
General Category => Aesthetics => Topic started by: jusken on February 10, 2019, 02:17:34 PM
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I've been scouring through these boards to see what people generally feel about their nose width post jaw surgery. I've mentioned this problem many times in regards to my case, as my nose has been widened quite a bit beyond my inner canthal distance. I've tried removing the hardware under my nose and then just dealing with it for a while (it's been about 5 years or so since my double jaw surgery). It just doesn't look right to me.
So I'm prepped to get a couple opinions from specialists on this matter, but also wanted to get the general feeling about rhinoplasty dealing with this. It seems like alar width reduction isn't a very popular operation to show before afters online. Mainly rhinoplasty galleries include lots of dorsal hump / tip work. So, is the scarring just too much of a tradeoff generally? Can a sill reduction alone hide the scars better and be preferable? These are questions that I'll ask, but I also feel that doctors just don't have to be totally honest about the statistics on these things.
Has anyone here addressed this or know someone who has and has been satisfied with the outcome?
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Not a specific suggestion of which doctor to go to but here's a link with some coverage as to base reduction.
https://www.drhilinski.com/rhinoplasty-tutorials/nasal-base
Here's a professional article with references to other doctors in the bibliography.
https://academic.oup.com/asj/article/22/3/289/183689
and another
https://www.semanticscholar.org/paper/Nasal-base-reduction-by-alar-release%3A-a-laboratory-Gruber-Freeman/8fe6b34838797e1de5e1d82b03190c52c15118fa
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frankly i can almost always see the scars from this procedure a mile away. and if you're a man you can't wear thick foundation or make-up to try and hide it.
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I've been scouring through these boards to see what people generally feel about their nose width post jaw surgery.
I don't like the changes to my nose either, but I'm not even sure what happened. It only looks slightly wider, but something about it looks off. The nostrils also look to be flared more after surgery.
Didn't Gunson do your original surgery?
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I don't like the changes to my nose either, but I'm not even sure what happened. It only looks slightly wider, but something about it looks off. The nostrils also look to be flared more after surgery.
Didn't Gunson do your original surgery?
Yeah Gunson did the surgery. I should clarify that looking at my old pictures my nose was slightly outside of my inner eye vertically, so the change isn't huge - but enough to make it look too wide to me now (it looks compressed). I notice this change with a lot of post jaw surgery pictures of patients, but probably depending on how wide your face is, this change can appear more minimal I think.
With me, my nostrils used to hang further down. With the jaw surgery, the base they sit on is higher up now and further forward. This has resulted in a straighter profile, but also a vertically compressed nose and more flared looking. When I look from the bottom, it's clear the nostrils aren't disproportionately flared, simply everything is wider (base + nostrils). The look isn't natural to me, even though the total width increase was probably only 1mm per side, maybe slightly more. It's clear that the nose is best left to naturally grow into the correct place if you can help it!
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Can you clarify whether this arose in the process of having CCW advancement to maxilla and also how many mm your maxilla was advanced out.
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I had CCW yes, it's standard with Gunson. I apologize, but I don't know which terms here mean what. My ANS was 2.6 and my PNS was 3.4. Are either of those relevant?
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It could be your ANS wasn't tripped to make up for it being more forward.
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I had CCW yes, it's standard with Gunson. I apologize, but I don't know which terms here mean what. My ANS was 2.6 and my PNS was 3.4. Are either of those relevant?
Here's a 'snip' from one of Gunson's displacement proposals.
A-P direction when positive conveys the 'pure' horizontal advancement of ANS and PNS
The Vert(ical) direction for ANS conveys whether ANS moved up or down. In this one it's 0
A PNS where the vertical has a POSITIVE sign means the PNS was moved down (which is the CCW) for this reading.
I'm wanting to know ANS A-P on yours, ANS Vert on yours, PNS A-P on yours and PNS Vert on yours.
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Ah, okay I'll just add a snippet of my movements then.
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Ah, okay I'll just add a snippet of my movements then.
Also mention if you got a multi-segment Lefort.
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I had the BSSO + LF1 if that's what you mean, yeah.
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The LF1 can be multi-segment. They cut it into (usually) three pieces and widen it. Did you have that?
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I had the BSSO + LF1 if that's what you mean, yeah.
Ah, okay I'll just add a snippet of my movements then.
OK, that tells me your ANS moved UP (1.9mm) in the vertical direction and your PNS moved DOWN (3.7) in vertical direction for the CCW aspect of it. Can you confirm if you had anterior impaction AND posterior downgraft ?
Also, was this 'single' lefort 1 or was it SEGMENTED? For example IF he had to cut the lefort into 3 pieces to move around the upper front teeth separately from the 2 adjoining upper sides (multi-segment Lefort 1), although I can't go through all the scenarios where they might do that, one of them is to give more WIDTH so that the back upper teeth occlude well with the back upper teeth to the mandible like when there is some narrowness to the transverse maxilla.
Short and sweet, no matter what the multi segment lefort 1 was for, that is IF you got one, it would tend to putting a 'stretch' near the nasal base. Also, since L1 brings the nasal base FORWARD, it's going to look wider to you because it's MORE in the foreground.
So, let's say you did NOT get a multi segment L1 and just 2.6mm horizontal advancement of ANS with 1.9mm impaction to anterior maxilla. That's enough for your nasal base to LOOK wider to you whether you look at in the mirror or take a photo of it. It's because the 'forward' advancement (and yes, even with CCW) brings the nasal base forward and puts it more in the foreground even though it might not be 'technically' wider.
However, IF you did get a multi-segment L1 which usually increases the transverse direction (width between the right and left side of the upper back teeth), that's something that veers toward a STRETCH to the nasal base to make it 'absolutely' or 'technically' wider.
I know someone who went to Gunson who got LESS nasal base advancement than you (but MORE CCW via posterior downgraft) than you BUT he also got the multi-segment L1 to increase the transverse width so the side teeth would meet better with about the 14 mm advancement of the B point he got and he got the very WIDE nasal base with BOTH. Although Gunson didn't prepare him for that, I DID so he knew what to expect. But he was OK with it and I think people can be OK with something like that when they know what the trade-offs can be ahead of time.
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Cool, thanks for the breakdown kavan. Yes, I remember Gunson talking to me about the multi-segment LF1 and the risks associated with it - so he did perform that.
I'm very confident that there is a fundamental problem with changing the shape of the nasal base - a nose adapts to a recessed maxilla and becomes longer, etc. This is a fairly obvious trade-off, I simply wasn't totally prepared for it going into it. Certain movements would clearly make a more unfavorable change, but in any case you're left with essentially a smaller space for the nose. This would produce a favorable change if you have a very narrow nose for instance or a wide face where such a small width increase is relatively less significant. Given all the jaw surgery cases I've seen, many people get a 'divergent' nasal shape - a slightly wide and flared look.
I'd change it 100% if there were no other trade-offs... but that seems unlikely here.
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Have you really seen bad scars from alar base reduction? I had 10mm straight advancement with Posnick and my nostril flare is pretty bad now so I was considering that in the future.
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Have you really seen bad scars from alar base reduction? I had 10mm straight advancement with Posnick and my nostril flare is pretty bad now so I was considering that in the future.
I've seen pretty terrible results with very visible scars, but I've also seen good results with very subtle scars. The question is: how often do the bad results happen even in skissed hands? This is clearly something that requires a specialist, I just don't like the external scar issue. I'm still going to get a couple opinions on it, but I've also become a lot more cautious generally with respect to surgical operations.
PS: is the word ski-lled not allowed?
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Cool, thanks for the breakdown kavan. Yes, I remember Gunson talking to me about the multi-segment LF1 and the risks associated with it - so he did perform that.
I'm very confident that there is a fundamental problem with changing the shape of the nasal base - a nose adapts to a recessed maxilla and becomes longer, etc. This is a fairly obvious trade-off, I simply wasn't totally prepared for it going into it. Certain movements would clearly make a more unfavorable change, but in any case you're left with essentially a smaller space for the nose. This would produce a favorable change if you have a very narrow nose for instance or a wide face where such a small width increase is relatively less significant. Given all the jaw surgery cases I've seen, many people get a 'divergent' nasal shape - a slightly wide and flared look.
I'd change it 100% if there were no other trade-offs... but that seems unlikely here.
Well, then. That explains the alar base width increase. The trade-off I was referring to was nose base changes as a function of advancing the maxilla EVEN WITH CCW and EVEN WITH Gunson.
Scars from a wedge section removal from the alar rim area in order to taper them in and narrow the width are hidden in the alar crease area. So, they should not be very visible providing you're light skinned, scar well and don't have keloid issues.
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I've seen pretty terrible results with very visible scars, but I've also seen good results with very subtle scars. The question is: how often do the bad results happen even in skissed hands? This is clearly something that requires a specialist, I just don't like the external scar issue. I'm still going to get a couple opinions on it, but I've also become a lot more cautious generally with respect to surgical operations.
PS: is the word ski-lled not allowed?
The work 'Ki-l-l' is not allowed as in someone having suicidal ideations wanting to do that to themselves. So words with that in it change.
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Have you really seen bad scars from alar base reduction? I had 10mm straight advancement with Posnick and my nostril flare is pretty bad now so I was considering that in the future.
I was hoping you would see this thread to reflect on the other thread.
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I should change that banned word list now that the lunatics have left the asylum.
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I should change that banned word list now that the lunatics have left the asylum.
Does that mean we're all still in the asylum
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Jusken, sorry to intrude into your thread, but since I’m due to have the same procedure, I would appreciate if you could spare some time to answer a few questions.
Since you had segmented lefort, have you encountered any problems or stability issues with regards to your bite or jaw?
Have you experienced any pain or nerve issues as a result of widening the maxilla? Have any root canal problems arisen as a result of the segmented lefort surgery?
How was Gunson’s post-operative care? How many years, if at all, does he continue to check up on your progress?
Lastly, after your initial consultation, how long did you have to wait for a surgery date?
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Jusken, sorry to intrude into your thread, but since I’m due to have the same procedure, I would appreciate if you could spare some time to answer a few questions.
Since you had segmented lefort, have you encountered any problems or stability issues with regards to your bite or jaw?
Have you experienced any pain or nerve issues as a result of widening the maxilla? Have any root canal problems arisen as a result of the segmented lefort surgery?
How was Gunson’s post-operative care? How many years, if at all, does he continue to check up on your progress?
Lastly, after your initial consultation, how long did you have to wait for a surgery date?
No stability issues. No pain or nerve issues (in upper lip area*), in fact the procedure was almost entirely painless from start to finish. I don't have any root canals, but haven't needed any either. Gunson did warn of teeth discoloration as a risk, but thankfully no problems there. Gunson's post-op care is very thorough and he mandates a good number of follow-ups. I saw Gunson up to about a year after - but only like once in the final 6 months of that period. It was about 5 months after my consult - but about 3 months after I decided to go through with it.
I could have gotten extremely luck for all I know in terms of avoiding risks - I did very little research prior to any of this. I consulted with one other orthognathic surgeon, and Gunson was far more thorough. Gunson is definitely very good, but I also don't want to deify him to anyone - all of these procedures are extremely medieval and you can easily come out worse off (especially for aesthetics only).
The only area that is fairly numb still for me is my lower lip, and I would put it at like 20% numb. This seems to be the most common area though given the accounts I've come across.
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No stability issues. No pain or nerve issues (in upper lip area*), in fact the procedure was almost entirely painless from start to finish. I don't have any root canals, but haven't needed any either. Gunson did warn of teeth discoloration as a risk, but thankfully no problems there. Gunson's post-op care is very thorough and he mandates a good number of follow-ups. I saw Gunson up to about a year after - but only like once in the final 6 months of that period. It was about 5 months after my consult - but about 3 months after I decided to go through with it.
I could have gotten extremely luck for all I know in terms of avoiding risks - I did very little research prior to any of this. I consulted with one other orthognathic surgeon, and Gunson was far more thorough. Gunson is definitely very good, but I also don't want to deify him to anyone - all of these procedures are extremely medieval and you can easily come out worse off (especially for aesthetics only).
The only area that is fairly numb still for me is my lower lip, and I would put it at like 20% numb. This seems to be the most common area though given the accounts I've come across.
Thanks a million for that, Jusken. Much appreciated! Agreed - there’s video of Raffaini doing orthognathic surgery on yt, from what I saw, it looked extremely grim. Anyway, good to hear everything went well.
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I wonder if maxillary setback would turn down the nose tip and/or reduce nostril flare? Or would those effects remain as a side effect of initial advancement. I have a feeling at least the flare would remain.
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I wonder if maxillary setback would turn down the nose tip and/or reduce nostril flare? Or would those effects remain as a side effect of initial advancement. I have a feeling at least the flare would remain.
Since your nose is supported by your maxilla, any changes will affect your nose. In a LF1, any displacement forward or up will cause some flaring - though CCW can mitigate this to some extent.
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though CCW can mitigate this to some extent.
In theory, but I've seen this happen with CCW a lot, too.
So it's something more complex. Might be the starting point with your nostrils, too. If they're a little flared to begin with, maybe you're just screwed no matter what way things move.
Edit: it looks like Kavan already touched on this above. Next time someone consults with Gunson maybe ask the exact reason why it happens even with CCW.
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Since your nose is supported by your maxilla, any changes will affect your nose. In a LF1, any displacement forward or up will cause some flaring - though CCW can mitigate this to some extent.
Yeah, I understand that. I'm wondering if reversing a LF1 would also reverse these effects.
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Yeah, I understand that. I'm wondering if reversing a LF1 would also reverse these effects.
You would also have to reverse the BSSO that went with the LF1.
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You would also have to reverse the BSSO that went with the LF1.
Yeah I'm aware. I'm just planning at some point to consult with Gunson to see if I was over-advanced and was/am a candidate for CCW-r. My hope is that he would be able to do a (partial) setback of both jaws plus ccw-r to maintain similar projection of the mandible.
I know the trade-offs with the nose can occur even with ccw and even with smaller movements. My question is just whether or not the LF1 portion of the setback would reduce the magnitude of those tradeoffs or if the flare is CAUSED by advancement but cannot be REVERSED by setback.
From some of the literature I've read, the amount of nasal flare is correlated with the amount of advancement (about 1:2), which seems about right in my case. My guess is the nasal 'tilt' would be reduced by a setback, but nostril flare seems harder to 'put back in the box'. But that's just intuition.
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In theory, but I've seen this happen with CCW a lot, too.
So it's something more complex. Might be the starting point with your nostrils, too. If they're a little flared to begin with, maybe you're just screwed no matter what way things move.
Edit: it looks like Kavan already touched on this above. Next time someone consults with Gunson maybe ask the exact reason why it happens even with CCW.
I've talked to Gunson about it, but I didn't press too much. He stated confidently that in his cases the nose doesn't change by more than 1mm, but mine did. I think this is a bit of an overconfidence issue and he mostly avoided it.
If you think about it just logically, CCW has the potential to cause an issue near the base of the nose. The rotation creates space higher up but nearer to the teeth is rotating forward and up. My nose flares out just at the bottom base - so this is congruent with this line of thinking. When you pair this with forward positioning, I can see where you inevitably get issues.
My thinking has changed over the years. I'm starting to think that especially in correcting long facial growth like mine, this is one of the trade offs you're left with through no real fault of the surgeon (although Gunson did over-promise in this regard). It could be said that I just have excess 'ala' because of that facial development. If this is true, it highlights how narrow the current methods are in addressing the problems associated with facial development - and how dubious it is to be recommended for aesthetics alone.
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Yeah I'm aware. I'm just planning at some point to consult with Gunson to see if I was over-advanced and was/am a candidate for CCW-r. My hope is that he would be able to do a (partial) setback of both jaws plus ccw-r to maintain similar projection of the mandible.
I know the trade-offs with the nose can occur even with ccw and even with smaller movements. My question is just whether or not the LF1 portion of the setback would reduce the magnitude of those tradeoffs or if the flare is CAUSED by advancement but cannot be REVERSED by setback.
From some of the literature I've read, the amount of nasal flare is correlated with the amount of advancement (about 1:2), which seems about right in my case. My guess is the nasal 'tilt' would be reduced by a setback, but nostril flare seems harder to 'put back in the box'. But that's just intuition.
You have to keep in mind that Posnick does not believe in alar cinches. (Wolford does. He thought that mine snapped too early. He would do another one in a revision. When I told him that I'd just seen a big name rhino surgeon who said that he's never seen them work, Wolford replied that when done properly they certainly do work.)
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You have to keep in mind that Posnick does not believe in alar cinches. (Wolford does. He thought that mine snapped too early. He would do another one in a revision. When I told him that I'd just seen a big name rhino surgeon who said that he's never seen them work, Wolford replied that when done properly they certainly do work.)
Yeah, I’m aware of this as well. The research I mentioned was for cases where no alar cinch was performed. I saw some studies suggesting the cinch does help but I know there is controversy about this.
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Yeah I'm aware. I'm just planning at some point to consult with Gunson to see if I was over-advanced and was/am a candidate for CCW-r. My hope is that he would be able to do a (partial) setback of both jaws plus ccw-r to maintain similar projection of the mandible.
I know the trade-offs with the nose can occur even with ccw and even with smaller movements. My question is just whether or not the LF1 portion of the setback would reduce the magnitude of those tradeoffs or if the flare is CAUSED by advancement but cannot be REVERSED by setback.
From some of the literature I've read, the amount of nasal flare is correlated with the amount of advancement (about 1:2), which seems about right in my case. My guess is the nasal 'tilt' would be reduced by a setback, but nostril flare seems harder to 'put back in the box'. But that's just intuition.
Your photos show that you already had some nasal flare. Seen by the large nose holes and how the alars spread out with a smile. Your cephs show that your ANS-PNS was already in a few degrees of CCW orientation and you've heard from one person who went to Gunson and who got CCW without even THAT much advancement, that he got a wider nose base. I think your first step would be to go back to Posnick in time to get the plates REMOVED (sometimes they can kick up inflammation) and being that he's also a PS, ask him to reduce the nasal base which is usually done by removing a wedge section from the alars similar to what they do with 'ethnic rhino'.
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Your photos show that you already had some nasal flare. Seen by the large nose holes and how the alars spread out with a smile. Your cephs show that your ANS-PNS was already in a few degrees of CCW orientation and you've heard from one person who went to Gunson and who got CCW without even THAT much advancement, that he got a wider nose base. I think your first step would be to go back to Posnick in time to get the plates REMOVED (sometimes they can kick up inflammation) and being that he's also a PS, ask him to reduce the nasal base which is usually done by removing a wedge section from the alars similar to what they do with 'ethnic rhino'.
I haven’t seen many b/a pics for any of Posnick’s rhinos so I don’t know how good he really is at them considering he specializes in maxfax and academia. Apparently reducing tilt/flare is a difficult procedure to get right and there are a few top PS in the DMV area with large galleries and extensive public reviews, so that seems like a better option. It’s hard to say whether plate removal would make a difference at all imo. But I’ll ask anyway.
I do still want to at least consult Gunson to get his opinion before doing anything as I want to make the decision to either go through with or avoid a revision with full confidence. Btw what are you getting approx for my OP angle? Maybe I’m doing it wrong
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I've talked to Gunson about it, but I didn't press too much. He stated confidently that in his cases the nose doesn't change by more than 1mm, but mine did. I think this is a bit of an overconfidence issue and he mostly avoided it.
Yes, I've had that same convo with him. I'm not sure why he says it when there are clear cases of widening, but it's better to under promise in that regard. My guess is he's trying to put the patient's mind at ease and thinks he can do 1mm, but it doesn't always happen, so might at well admit it can be bad.
If you think about it just logically, CCW has the potential to cause an issue near the base of the nose. The rotation creates space higher up but nearer to the teeth is rotating forward and up. My nose flares out just at the bottom base - so this is congruent with this line of thinking. When you pair this with forward positioning, I can see where you inevitably get issues.
Yes, agree with the mechanics.
I don't think A/G trim the ANS, either? Anyone know? If done that could help, in theory.
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Yes, I've had that same convo with him. I'm not sure why he says it when there are clear cases of widening, but it's better to under promise in that regard. My guess is he's trying to put the patient's mind at ease and thinks he can do 1mm, but it doesn't always happen, so might at well admit it can be bad.
Yes, agree with the mechanics.
I don't think A/G trim the ANS, either? Anyone know? If done that could help, in theory.
That helps when the upper lip is TETHERED to the base of the nose. Here's a link where a rhino doc shows what tethering looks like. http://www.facialsurgery.com/ClkoffTPgt3_2011_09_03bh.html
Here's another photo of what is meant by this TETHERING. (http://www.makemeheal.com/video/uservideo/kissy1/nose.jpg_small.jpg)
But if a person doesn't actually have THAT, cutting down or cutting off the nasal spine would be removing support to the nasal base and that might make the tip rotate down and create a very sharp acute nose to lip angle.
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Yes, I've had that same convo with him. I'm not sure why he says it when there are clear cases of widening, but it's better to under promise in that regard. My guess is he's trying to put the patient's mind at ease and thinks he can do 1mm, but it doesn't always happen, so might at well admit it can be bad.
Because they consider it a GOOD functional thing, especially for breathing when the nose holes get bigger. It's one of the functional 'perks' of CCW. So, it's not something you'd be avoiding by getting CCW. But he down plays that part because he over plays the 'increased aesthetics' part.
Wolford mentions it outright on one of his pages and mentions it within the context of CCW being great for increasing the airways. Nose holes are airways too, you know.
Dr. Wolford says:
As the maxillary and mandibular complex is advanced forward in a counter-clockwise direction the overall facial balance is improved, the oropharyngeal airway opens and the nostrils are widened; all to improve the airway. Our studies have shown that with the first 10 mm of advancement, the oropharyngeal airway opens up 65-70% of the amount of mandibular advancement. With 10 to 15 mm of advancement, the oropharyngeal airway continues to open, but at a lesser percentage of the amount of mandibular advancement of only about 55-60% of the mandibular advancement. When the mandible is advanced greater than 15 mm, the oropharyngeal airway continues to open, but only about 40-45% of the amount of mandibular advancement.
ref= http://www.drlarrywolford.com/orthognathic-corrective-jaw-surgery/
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Post Bimax - So if Posnick does not believe in alar cinches, did he still do one on you?
I don't think A/G trim the ANS, either? Anyone know? If done that could help, in theory.
I've been wondering about this.
I just assumed they did do ANS shaving, because in some of the A/G before & afters I've seen online, their patients' noses don't seem to significantly upturn in profile view. They maybe slightly upturn, but no dramatic ski slopes/piggy noses you sometimes see with other surgeons. It looks more controlled.
But then again, what I'm seeing in before & afters might just be an illusion - where upturning is occurring but it doesn't look as obvious due to other changes such as better lip curve etc.
Jusken - besides the alar base widening, did you have significant tip upturn?
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April- No, I don’t think so. If he did he didn’t tell me but I never asked and it’s not standard with him. I didn’t even know about it at the time.
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Post Bimax - So if Posnick does not believe in alar cinches, did he still do one on you?
I've been wondering about this.
I just assumed they did do ANS shaving, because in some of the A/G before & afters I've seen online, their patients' noses don't seem to significantly upturn in profile view. They maybe slightly upturn, but no dramatic ski slopes/piggy noses you sometimes see with other surgeons. It looks more controlled.
But then again, what I'm seeing in before & afters might just be an illusion - where upturning is occurring but it doesn't look as obvious due to other changes such as better lip curve etc.
Jusken - besides the alar base widening, did you have significant tip upturn?
I don't think my nose upturned much if at all, but did become straighter in profile and more in line with my hump (more forward?).
ANS shaving might help with the upturning in some cases, but I don't think it would work for flaring unless in some rare cases.
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That helps when the upper lip is TETHERED to the base of the nose. Here's a link where a rhino doc shows what tethering looks like. http://www.facialsurgery.com/ClkoffTPgt3_2011_09_03bh.html
Here's another photo of what is meant by this TETHERING. (http://www.makemeheal.com/video/uservideo/kissy1/nose.jpg_small.jpg)
But if a person doesn't actually have THAT, cutting down or cutting off the nasal spine would be removing support to the nasal base and that might make the tip rotate down and create a very sharp acute nose to lip angle.
Hi kavan, this is my first post so sorry if I seem ignorant.
What would you say is the best way for a patient to reduce the amount of upturning of the nose on a big maxillary advancement (underbite)?
Would cutting down the nasal spine downturn the nasal tip (which i want)? Even at the cost of bigger alar base, that is preferable since I can just do an alar base reduction which is alot simpler than a surgery to fix a pignose
Thanks kavan. Need some experts on this matter and truly appreciate it.
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Hi kavan, this is my first post so sorry if I seem ignorant.
What would you say is the best way for a patient to reduce the amount of upturning of the nose on a big maxillary advancement (underbite)?
Would cutting down the nasal spine downturn the nasal tip (which i want)? Even at the cost of bigger alar base, that is preferable since I can just do an alar base reduction which is alot simpler than a surgery to fix a pignose
Thanks kavan. Need some experts on this matter and truly appreciate it.
This is an old thread, a long one and one that applied to the original poster. My advice is start your own thread if you're seeking collective advice targeted to you.