jawsurgeryforums.com
General Category => Aesthetics => Topic started by: ODog on February 16, 2019, 01:52:43 PM
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Hi guys,
I emailed Dr. Z about doing a chin wing after my bi-max surgery to lower my jaw angles but he replied saying “BSSO typically destroys the lower mandible border making CW very difficult or impossible.” I actually don’t even want a CW but a side wing. He also said the same thing for the zygoma osteotmy after a “high lefort 1 advancement of maxilla,” (it makes it difficult/ impossible), although I’m not sure what he meant by “high” as I’m just getting the traditional lefort cut.
I was positive I’ve read of accounts of people getting bi-max first and then CW. Wasn’t there a poster SJ who did just that? Would another osteotomy surgeon in Europe be willing to do this ?
I’m disapointed.
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Hi guys,
I emailed Dr. Z about doing a chin wing after my bi-max surgery to lower my jaw angles but he replied saying “BSSO typically destroys the lower mandible border making CW very difficult or impossible.” I actually don’t even want a CW but a side wing. He also said the same thing for the zygoma osteotmy after a “high lefort 1 advancement of maxilla,” (it makes it difficult/ impossible), although I’m not sure what he meant by “high” as I’m just getting the traditional lefort cut.
I was positive I’ve read of accounts of people getting bi-max first and then CW. Wasn’t there a poster SJ who did just that? Would another osteotomy surgeon in Europe be willing to do this ?
I’m disapointed.
SJ engaged in a lot of DECEPTION on this board. If his accounts of having a chin wing/side wing post BSSO influenced you to seek out dr. Z, then the ball was in your court to have asked Z about accounts you read on here that said he did chin/side wings after a BSSO.
Even if you ask the OTHER CW doctors; Brusco and Triaca in Switzerland, consider you are asking them if they can give you a chin wing after a surgery you haven't even had yet. All 3 of them can't tell you for sure, not knowing what they will be dealing with. I mean, you DON'T have X rays to show regarding a surgery TO BE done later down the line. (No one would.)
They might want to do ALL the surgery in order to do the chin wing with it or later down the line because it's probably easier for them to do the CWs where they alter the cuts or rotations with the Lefort and/or the BSSO in order to do the chin wing.
Other than that, if you really want a chin wing, either wait until your surgery is done so you have X rays of the cuts that they can see and then tell you if possible OR consult directly with them regarding either 1 of those 3 doing ALL your surgery.
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Thanks Kavan. The latter isn’t an option because bi-max + side Wing is out of my budget range at the moment. That would be around $35,000. I’ll have to consult them afterward I guess. Visually speaking I’m not sure why a BSSO would make a side wing harder, chin wing yeah I can understand because you’re cutting further down where the BSSO cut was made, which is probably what he means by “the border is destroyed with BSSO,” but with SW the cut is at the back only, I.e there’s no sliding forward movement or anterior mandible dropdown needed in my case as that will be accomplished with my genio and BSSO. I just want a wider, squarer jaw at the back
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Thanks Kavan. The latter isn’t an option because bi-max + side Wing is out of my budget range at the moment. That would be around $35,000. I’ll have to consult them afterward I guess. Visually speaking I’m not sure why a BSSO would make a side wing harder, chin wing yeah I can understand because you’re cutting further down where the BSSO cut was made, which is probably what he means by “the border is destroyed with BSSO,” but with SW the cut is at the back only, I.e there’s no sliding forward movement or anterior mandible dropdown needed in my case as that will be accomplished with my genio and BSSO. I just want a wider, squarer jaw at the back
Then you're better off with implants some time after your bi-max.
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Yeah at least I’ll have that option but I wanted to a more natural result. Oh well.
Polsko I’ve read some of your past posts about your surgery. Did everything work out? Did you end up getting a revision. How are your nerves ?
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Thanks Kavan. The latter isn’t an option because bi-max + side Wing is out of my budget range at the moment. That would be around $35,000. I’ll have to consult them afterward I guess. Visually speaking I’m not sure why a BSSO would make a side wing harder, chin wing yeah I can understand because you’re cutting further down where the BSSO cut was made, which is probably what he means by “the border is destroyed with BSSO,” but with SW the cut is at the back only, I.e there’s no sliding forward movement or anterior mandible dropdown needed in my case as that will be accomplished with my genio and BSSO. I just want a wider, squarer jaw at the back
IDK. Maybe still too close for comfort. He probably wants to make his own cuts with bi-max to give him leeway for any cuts he does to the mandible or now prefers people with 'virgin' jaws.
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'virgin' jaws.
:o
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:o
Hahahaha LoL
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Uhm as far as I know Dr. Z has done ching wing and/or side wing on a number of bi-max patients.
I personally don't think SJ was lying about having had two chin-wings (or side wings I don't know which) after having had bi-max with another Italian surgeon.
This is very concerning/strange news. Also not doing the ZSO after bi-max sounds counter to what I've heard as well. So confused.
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Uhm as far as I know Dr. Z has done ching wing and/or side wing on a number of bi-max patients.
I personally don't think SJ was lying about having had two chin-wings (or side wings I don't know which) after having had bi-max with another Italian surgeon.
This is very concerning/strange news. Also not doing the ZSO after bi-max sounds counter to what I've heard as well. So confused.
I think something has changed because I emailed Z last year indicating I was getting upper jaw surgery and asked about the zygoma procedure and he didn’t say I would be disqualified. This could be something new and I asked him if that’s the case but he didn’t respond. This was his response to me..
“if you will have conventional BSSO and not a higher one,
they very often destroy the lower border of the mandible, because of bone resorption at the end of the osteotomy line, therefore it can be that side wing or chin wing osteotomy is very difficult or impossible afterwards, in the maxilla it is the other way round, when higher Le Fort I is used,
zygoma osteotomy is more difficult and not so effective afterwards.”
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Uhm as far as I know Dr. Z has done ching wing and/or side wing on a number of bi-max patients.
I personally don't think SJ was lying about having had two chin-wings (or side wings I don't know which) after having had bi-max with another Italian surgeon.
This is very concerning/strange news. Also not doing the ZSO after bi-max sounds counter to what I've heard as well. So confused.
Well time for you too to know that SJ engaged in DECEPTION as far as this board goes. Con games are all about being truthful in some things TO BE deceptive about other things. So go figure.
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Well time for you too to know that SJ engaged in DECEPTION as far as this board goes. Con games are all about being truthful in some things TO BE deceptive about other things. So go figure.
I also do not think he was deceptive in the procedures he had done. I’m pretty sure he was class II before and had that fixed. Wouldn’t make sense for him to lie about getting jaw surgery because if his goal was to solely get referral kickbacks for CW, then it would’ve been in his best interest to pawn his results off as being the result of CW only.
It also doesn’t make sense why he would lie about getting “two” CWs as, again, if his goal was to attract interest in the CW this would detract from that as it would make it seem like an ineffective procedure if it needed to be repeated. If the whole thing was a lie, he would’ve just said “Hey look I got this one cheap procedure and it changed everything for me.” And didn’t he admit he STILL needed fillers afterward? I mean if he made all of that up then he’s a horrendous salesman because it makes CW sound sketchy like a crap shoot .
Obviously it’s possible he lied, but I think it’s more likely Dr. Z may have recently experienced complications in post Bi-max patients and this has changed his mind on who he accepts.
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I think something has changed because I emailed Z last year indicating I was getting upper jaw surgery and asked about the zygoma procedure and he didn’t say I would be disqualified. This could be something new and I asked him if that’s the case but he didn’t respond. This was his response to me..
“if you will have conventional BSSO and not a higher one,
they very often destroy the lower border of the mandible, because of bone resorption at the end of the osteotomy line, therefore it can be that side wing or chin wing osteotomy is very difficult or impossible afterwards, in the maxilla it is the other way round, when higher Le Fort I is used,
zygoma osteotomy is more difficult and not so effective afterwards.”
This is what I told you in other posts in this string which resolves to IF you don't get the type of BSSO that HE does SO he CAN do the the chin wing, he's not going to promise or imply to promise he will do your chin wing.
Who the f**k knows. Maybe he 's trying to distance himself from SJ promoting him and people coming in THAT way.
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I also do not think he was deceptive in the procedures he had done. I’m pretty sure he was class II before and had that fixed. Wouldn’t make sense for him to lie about getting jaw surgery because if his goal was to solely get referral kickbacks for CW, then it would’ve been in his best interest to pawn his results off as being the result of CW only.
It also doesn’t make sense why he would lie about getting “two” CWs as, again, if his goal was to attract interest in the CW this would detract from that as it would make it seem like an ineffective procedure if it needed to be repeated. If the whole thing was a lie, he would’ve just said “Hey look I got this one cheap procedure and it changed everything for me.” And didn’t he admit he STILL needed fillers afterward? I mean if he made all of that up then he’s a horrendous salesman because it makes CW sound sketchy like a crap shoot .
Obviously it’s possible he lied, but I think it’s more likely Dr. Z may have recently experienced complications in post Bi-max patients and this has changed his mind on who he accepts.
What the f**ck don't you understand about CON games? They are all about being truthful in ONE thing to gain confidence so they can be deceptive about OTHER things. Maybe Z doesn't want people coming in THROUGH SJ. Good for Z if that is the case. Go ahead. Be an apologist for SJ and I shall consider you BEYOND help.
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What the f**ck don't you understand about CON games? They are all about being truthful in ONE thing to gain confidence so they can be deceptive about OTHER things. Maybe Z doesn't want people coming in THROUGH SJ. Good for Z if that is the case. Go ahead. Be an apologist for SJ and I shall consider you BEYOND help.
I’m not coming in through SJ in the slightest. In fact his isolated experience turns me off from it. I am interested in CW because of what it can theoretically do. I only commented on SJ because it’s relevant that he had prior jaw surgery. His relevance to this thread stops there.
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I’m not coming in through SJ in the slightest. In fact his isolated experience turns me off from it. I am interested in CW because of what it can theoretically do. I only commented on SJ because it’s relevant that he had prior jaw surgery. His relevance to this thread stops there.
If SJ's stuff is what let you know about CW's and Z, than you would be coming in with SJ's stuff. Either way, people who want Z's chin wing look like they will also either need to have 'virgin' jaws OR have Z do the L1 and BSSO work/cuts.
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If SJ's stuff is what let you know about CW's and Z, than you would be coming in with SJ's stuff. Either way, people who want Z's chin wing look like they will also either need to have 'virgin' jaws OR have Z do the L1 and BSSO work/cuts.
Yeah I have a feeling you're right that his recent experiences have not been satisfactory on patients who have already had bi-max. Jeesh, another thing that just sucks in the world. I think I should just become a Buddhist monk and accept all is suffering.
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I know it sucks I really didn’t want to go the implant route. Really disapointed.
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If SJ's stuff is what let you know about CW's and Z, than you would be coming in with SJ's stuff. Either way, people who want Z's chin wing look like they will also either need to have 'virgin' jaws OR have Z do the L1 and BSSO work/cuts.
Strange. Part of Triaca's sales pitch is that chin wings allow to camouflage dodgy bssos. A few people here had them done for this very reason.
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I am going to email Triaca then and some others.
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SJ is still extremely recessed, after bi-max and at least one chin wing, though I do think he had two.
He's been doing crazy plastic surgery procedures to try to mask everything, and now he just looks flat out odd.
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fwiw, I have spoke to dr. brusco and he mentioned that a chin wing is possible after bi-max, but like others have said, they would need to see the end result of your bimax to see if a chin wing was doable. I think Z is pretty much indicating the same, but prefers to do it all together himself so he has control over movements.
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Strange. Part of Triaca's sales pitch is that chin wings allow to camouflage dodgy bssos. A few people here had them done for this very reason.
Could be. But as far as sales pitches or claims go, it all boils down to candidacy. What kind of BSSO someone had would relate to candidacy for chin wing.
3 basic variations; The Trauner-Obwegeser (TO), Obwegeser (Ob), and Obwegeser-Dal Pont (OD).
First one, 'TO' is basically the type they call 'high BSSO' and prefer to use when they are also going to add a chin wing to the surgery or maybe do one later down the line. Last one; 'OD' is the more modern one and commonly used BSSO. Middle one, somewhere in-between.
Here's a clip of the 3 basic BSSO variations.
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fwiw, I have spoke to dr. brusco and he mentioned that a chin wing is possible after bi-max, but like others have said, they would need to see the end result of your bimax to see if a chin wing was doable. I think Z is pretty much indicating the same, but prefers to do it all together himself so he has control over movements.
Thanks for sharing. Be careful with Dr. Brusco he totally screwed up BenFromUK... as far as I understand, instead of dropping down the back jaw angles he made the cut further down and dropped the front/ middle part of the mandible, elongating the wrong part of the face which was already long to begin with. He’s now getting implants put in to fix the mistake.
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Could be. But as far as sales pitches or claims go, it all boils down to candidacy. What kind of BSSO someone had would relate to candidacy for chin wing.
3 basic variations; The Trauner-Obwegeser (TO), Obwegeser (Ob), and Obwegeser-Dal Pont (OD).
First one, 'TO' is basically the type they call 'high BSSO' and prefer to use when they are also going to add a chin wing to the surgery or maybe do one later down the line. Last one; 'OD' is the more modern one and commonly used BSSO. Middle one, somewhere in-between.
Here's a clip of the 3 basic BSSO variations.
Good post.
Looks like the popular cut maintains more bone contact and allows for larger advancement vs the chin wing optimised cut.
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SJ is still extremely recessed, after bi-max and at least one chin wing, though I do think he had two.
He's been doing crazy plastic surgery procedures to try to mask everything, and now he just looks flat out odd.
Yep. Very disappointing that a big name like Pelo could not even give him a decent bite. That's the absolute minimum a surgeon should do.
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Good post.
Looks like the popular cut maintains more bone contact and allows for larger advancement vs the chin wing optimised cut.
Yes indeed. The popular cut (3rd one) allows for the most advancement and the one that's usually combined with the CCW.
According to one study (the one I found the diagrams on), the 3rd cut was found to be the most stable.
The first cut didn't start out as a chin wing optimized cut. it was just an EARLIER version of the BSSO.
But as you can see by looking at the 1rst one, which is what the chin wing docs call 'High BSSO', you can see why they like that because it IS optimized to do a CW because where they cut to do a chin wing does not traverse the cut the do for the high BSSO.
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I don't even know what BSSO cut I got.
I had an aggressive genioplasty so I don't think a chin wing is even appropriate for me, unless I guess to lower the ramus area. What kind of chin wing is that? Is that what's called a wing osteotomy or something?
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I don't even know what BSSO cut I got.
I had an aggressive genioplasty so I don't think a chin wing is even appropriate for me, unless I guess to lower the ramus area. What kind of chin wing is that? Is that what's called a wing osteotomy or something?
That's a side wing and it doesn't matter; if your cut is the one Dr. Z and Kavan is saying disqualifies you, it would be for both chin wing and side wing.
He did give a follow-up response to me when I asked if this was a new approach he was taking, and he said "it's not always the case, but very often."
I guess the next thing to determine is why some BSSO cuts are preferred to others and why. Is it arbitrary? Does it depend on the surgeon?
I am getting 6-7 mm advancement, which I would say is a moderate movement, so maybe my surgeon won't make the cut Kavan is saying is for "larger movement." Who knows... but I'm not about to tell my surgeon where to cut my mandible lol.
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Most BSSO's are the modern ones which is the 3rd one .
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So would it matter if you had your lower hardware removed? I didn't have a "high" bsso as far as I know. But then I had the hardware removed on both sides cause of different causes (on an infection and the other the surgeon just took it out while correcting some scar tissue).
So there shouldn't be any reason the side wing can't still be done.
I mean is Dr. Z at least willing to see you to consult with whether you can have the procedure done?
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Most BSSO's are the modern ones which is the 3rd one .
okay and the third one does not disqualify you correct?
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okay and the third one does not disqualify you correct?
No, the 3rd one that is MOST used in maxfax bi max is the one that can disqualify you (from chin wing). The 1rst is the 'high' BSSO that the chin wing docs like.
ETA: They don't want to cut through the SPLIT area of that (3rd) BSSO. The split area on the 1rst one is HIGHER so the chin wing cut doesn't go through the split area.
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No, the 3rd one that is MOST used in maxfax bi max is the one that can disqualify you (from chin wing). The 1rst is the 'high' BSSO that the chin wing docs like.
ETA: They don't want to cut through the SPLIT area of that (3rd) BSSO. The split area on the 1rst one is HIGHER so the chin wing cut doesn't go through the split area.
So this is what I’m wondering. The first diagram below you see a traditional chin wing where the ENTIRE lower border is cut and dropped/ advanced. This adds vertical length to the entire mandible, which is what the procedure was initially designed for, so the cut needs to be all the way down which traverses the most common BSSO (3rd) cut. Bad.
In the second diagram the cut is made at the back, but what if instead of mobilizing the entire border the cut is stopped somewhere near where I drew the red line, so that it doesn’t traverse the BSSO cut. I mean in a side wing you don’t even want to drop the whole border anyway as you only want dropdown at the back, so the question is, would you need to mobilize the entire border even in a side wing?
I’m thinking you probably have to because the drop down needs to be gradual. I’m not sure you can aggressively bend down the back where my red line is drawn without cutting further down to allow for a more gradual dropdown.
This is probably why Dr. Z said BSSOs are problematic for both SWs and CWs.
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There is still a SPLIT where you drew your red line. Look at the diagrams I provided. The whole split is behind the GREEN part which is why it's called a SAGITTAL split. You're just looking at part where they move the mandible forward after they make the split.
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Oh now I get it. The entire border all the way up to the ramus is split, I wasn’t visualizing that. So Z was right. So he said it’s not always the case the border is destroyed, I wonder if he’s referring to how it heals, etc. Because it seems to me that all 3 cuts destroy the mandible border because there’s a split all the way up.
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Sidewing depends on 'elasticity' of the bone. Can't be done with everyone. In fact, there isn't a clear pic of anyone that has done a sidewing, despite SJ, and he also appearantly did fillers. I wanted a sidewing besides cw, surgeon promised that, I got more ruined golonial angles. Maybe there are people with good sidewing results. But you almost never hear from people's experience unfortunately.
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Sidewing depends on 'elasticity' of the bone. Can't be done with everyone. In fact, there isn't a clear pic of anyone that has done a sidewing, despite SJ, and he also appearantly did fillers. I wanted a sidewing besides cw, surgeon promised that, I got more ruined golonial angles. Maybe there are people with good sidewing results. But you almost never hear from people's experience unfortunately.
You got ruined goinal angles because the surgeon segmented the wrong section of your mandible. Hard to believe, but he messed up. CW is going to blunt your angels but a side wing should not. How could it ?
There is a user here, Optimistic, that apparently had great results with a side wing. Obviously we will never see the results. The thing is, you can always get an implant later if it truly is a worthless procedure.
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Thanks Kavan your pics weren’t loading for me the other day so I was going off memory.
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This was Dr. Z’s explanation.....
“if the distance after conventional BSSO from the lower border to the nerve is too small Side Wing or Chin Wing are not possible anymore. And: Small segment (makes for ?) difficult fixation, higher risk of resorption, possible step in Jaw Line.”
The latter part I think was in response to me asking if he could segment only a small part of the back jaw for the side wing. So it seems the real issue is the distance from lower border to nerve? But isn’t that the case even if you don’t get a BSSO? I’m confused.
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This was Dr. Z’s explanation.....
“if the distance after conventional BSSO from the lower border to the nerve is too small Side Wing or Chin Wing are not possible anymore. And: Small segment (makes for ?) difficult fixation, higher risk of resorption, possible step in Jaw Line.”
The latter part I think was in response to segmenting on a small part of the back jaw for the side wing. So it seems the real issue is the distance from lower border to nerve? But isn’t that the case even if you don’t get a BSSO? I’m confused.
It is. But a standard bsso can make that issue worse. Save your money and find a surgeon who will do a proper CCW surgery on you.
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It is. But a standard bsso can make that issue worse. Save your money and find a surgeon who will do a proper CCW surgery on you.
My surgery is March 18 and most of it is covered by insurance so I’m going forward with it. I’m also getting bi-max advancement which would be more than 30k + in the US. Besides, I have no tooth show so wouldn’t CCW make that worse? No surgeon has been able to satisfactorily explain if I’m a CCW case or not.
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My surgery is March 18 and most of it is covered by insurance so I’m going forward with it. I’m also getting bi-max advancement which would be more than 30k + in the US. Besides, I have no tooth show so wouldn’t CCW make that worse? No surgeon has been able to satisfactorily explain if I’m a CCW case or not.
No tooth show could be due to a long upper lip or vertical maxillary deficiency. In the first case, you get a lip lift and then surgery. In the other case you can still have CCW if your occlusal plane is steep - downgraft both at the front and the back of the maxilla, but more at the back to produce ccw rotation.
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I feel like improving tooth show is completely doable for CCW in the right hands.
Dr. Arnett in my previous consultation a long time ago when he was still practicing indicated the need for greater tooth show and that he would address that even though he was doing a massive CCW rotation. He also said support for the upper lip would be better.
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No tooth show could be due to a long upper lip or vertical maxillary deficiency. In the first case, you get a lip lift and then surgery. In the other case you can still have CCW if your occlusal plane is steep - downgraft both at the front and the back of the maxilla, but more at the back to produce ccw rotation.
Yeah that’s what it is, vertical maxillary deficiency at the front, excess in the back. My philthrum is probably on the long side of normal but when I asked my surgeon if long philthrum was the cause he said no it’s normal and measured twice to confirm.
Basically in Canada I’d be shocked if a surgeon would offer CCW via downgrafts purely for aesthetics ( autorotation of mandible) and without there being some clear indication like excess gum show. My jawline is steep but not severely so, so implants or CW could fix that no problem.
I do have sleep apnea hence the bi-max, but again I’m not sure how much CCW would help that.
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I feel like improving tooth show is completely doable for CCW in the right hands.
Dr. Arnett in my previous consultation a long time ago when he was still practicing indicated the need for greater tooth show and that he would address that even though he was doing a massive CCW rotation. He also said support for the upper lip would be better.
I’m sure there are ways like Plosko said lip lift or downgrafts but how much would a bi-max with CCW and genio cost with Gunson? Probably 6X what I’m paying here. I don’t know. Maybe it is indeed worth it to save up. Chin wing would solve the issue though.
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I feel like improving tooth show is completely doable for CCW in the right hands.
Dr. Arnett in my previous consultation a long time ago when he was still practicing indicated the need for greater tooth show and that he would address that even though he was doing a massive CCW rotation. He also said support for the upper lip would be better.
Lazlo you’ve had double jaw right and are interested in a chin wing? You should get a 3D come beam scan done local to you and email it to Dr. z to see what he says....
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Lazlo you’ve had double jaw right and are interested in a chin wing? You should get a 3D come beam scan done local to you and email it to Dr. z to see what he says....
Well I will do something like that but I feel the more prudent thing would be to get a CCW revision to my existing jaw surgery I'm not totally happy with.
I can imagine getting a chinwing would be something in the way of getting revision jaw surgery, am I right?
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Yeah that’s what it is, vertical maxillary deficiency at the front, excess in the back. My philthrum is probably on the long side of normal but when I asked my surgeon if long philthrum was the cause he said no it’s normal and measured twice to confirm.
Basically in Canada I’d be shocked if a surgeon would offer CCW via downgrafts purely for aesthetics ( autorotation of mandible) and without there being some clear indication like excess gum show. My jawline is steep but not severely so, so implants or CW could fix that no problem.
I do have sleep apnea hence the bi-max, but again I’m not sure how much CCW would help that.
If you have anterior open bite/excess in the back AND a close to 'flat' OP, it's doubtful you will be getting CCW. A wedge from the back would most likely need to be removed (posterior impaction)= CW and more anterior tooth show is a wedge downward which also is CW.
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No tooth show could be due to a long upper lip or vertical maxillary deficiency. In the first case, you get a lip lift and then surgery. In the other case you can still have CCW if your occlusal plane is steep - downgraft both at the front and the back of the maxilla, but more at the back to produce ccw rotation.
Yeah that is possible but would require the unstable downgraft, in conjunction with what many feel is already an unstable movement in CCW.
This is why these class II cases are the hardest of all. Underbites look worse, but have it easier at surgery time.
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Lazlo you’ve had double jaw right and are interested in a chin wing? You should get a 3D come beam scan done local to you and email it to Dr. z to see what he says....
OR Lazlo could look at the diagram of the different BSSO types, note that type #3 is the Obwegeser dal pont osteotomy and ask his doctor if he had that one--the most common one-- OR he could just e mail the chin wing doctor his post op ceph where it could be seen what type he had. No cone beam scan needed for him to find out if his BSSO precludes him from a chin wing.
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If you have anterior open bite/excess in the back AND a close to 'flat' OP, it's doubtful you will be getting CCW. A wedge from the back would most likely need to be removed (posterior impaction)= CW and more anterior tooth show is a wedge downward which also is CW.
Yes that’s my case, anterior open bite with close to flat OP.
The initial plan with my first surgeon was posterior impaction but they never explained how that would translate to CCW. As far as I knew that would mean CW as you’re saying now, Kavan? My orthodontist said it would “shorten my face.”
The anterior tooth show will apparently be fixed with forward advancement. My upper lip is very flat... 90 degrees to base of nose so that could be contributing as well.
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OR Lazlo could look at the diagram of the different BSSO types, note that type #3 is the Obwegeser dal pont osteotomy and ask his doctor if he had that one--the most common one-- OR he could just e mail the chin wing doctor his post op ceph where it could be seen what type he had. No cone beam scan needed for him to find out if his BSSO precludes him from a chin wing.
Get on that Lazlo. Kidding lol... that’s what I’ll do after I get the Ceph from my surgery.
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Yes that’s my case, anterior open bite with close to flat OP.
The initial plan with my first surgeon was posterior impaction but they never explained how that would translate to CCW. As far as I knew that would mean CW as you’re saying now, Kavan? My orthodontist said it would “shorten my face.”
The anterior tooth show will apparently be fixed with forward advancement. My upper lip is very flat... 90 degrees to base of nose so that could be contributing as well.
Posterior impaction could “shorten” your face by allowing your mandible to swing closer to “flat” when your mouth is closed.
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Yes that’s my case, anterior open bite with close to flat OP.
The initial plan with my first surgeon was posterior impaction but they never explained how that would translate to CCW. As far as I knew that would mean CW as you’re saying now, Kavan? My orthodontist said it would “shorten my face.”
The anterior tooth show will apparently be fixed with forward advancement. My upper lip is very flat... 90 degrees to base of nose so that could be contributing as well.
Yes a CW rotation would be needed via posterior impaction and some CW probably to anterior maxilla to rotate down and make the OP less flat. Well, a NET clockwise rotation does not change into CCW. You only get a net CCW with for example a posterior down graft that is larger in the back than the anterior downgraft they put to the front for more tooth show. You'r NOT gettting a posterior downgraft. Not done with vertically long posterior maxilla. Posterior impaction is CW but it does allow your jaw to swing upward to CLOSE the bite because it's the BACK teeth forcing the back of the lower jaw downward. That is what the ortho means by it will 'shorten'.
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OR Lazlo could look at the diagram of the different BSSO types, note that type #3 is the Obwegeser dal pont osteotomy and ask his doctor if he had that one--the most common one-- OR he could just e mail the chin wing doctor his post op ceph where it could be seen what type he had. No cone beam scan needed for him to find out if his BSSO precludes him from a chin wing.
haha thanks Kavan, makes my life easier. What did I say on the other thread: ASK KAVAN!!!
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My surgery is March 18 and most of it is covered by insurance so I’m going forward with it. I’m also getting bi-max advancement which would be more than 30k + in the US. Besides, I have no tooth show so wouldn’t CCW make that worse? No surgeon has been able to satisfactorily explain if I’m a CCW case or not.
I hope you don't decide to have surgery because it's cheap. A bad surgery is worse than no surgery.
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Yes a CW rotation would be needed via posterior impaction and some CW probably to anterior maxilla to rotate down and make the OP less flat. Well, a NET clockwise rotation does not change into CCW. You only get a net CCW with for example a posterior down graft that is larger in the back than the anterior downgraft they put to the front for more tooth show. You'r NOT gettting a posterior downgraft. Not done with vertically long posterior maxilla. Posterior impaction is CW but it does allow your jaw to swing upward to CLOSE the bite because it's the BACK teeth forcing the back of the lower jaw downward. That is what the ortho means by it will 'shorten'.
Right so it would be beneficial fixing the open bite with posterior impaction. But then how is my new surgeon planning on bypassing the posterior impaction ?? He’ll fix the open bite with just forward advancement ?
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I hope you don't decide to have surgery because it's cheap. A bad surgery is worse than no surgery.
Why do you think my surgery will be bad? Now I’m doubting it. I don’t think my open bite is significant, so my new surgeon didn’t think it was an issue. I believe the impaction would be quite small if it was done.
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Right so it would be beneficial fixing the open bite with posterior impaction. But then how is my new surgeon planning on bypassing the posterior impaction ?? He’ll fix the open bite with just forward advancement ?
He can downgraft the anterior maxilla to close the bite without posterior impaction.
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Right so it would be beneficial fixing the open bite with posterior impaction. But then how is my new surgeon planning on bypassing the posterior impaction ?? He’ll fix the open bite with just forward advancement ?
Posterior impaction is a modality used to help close an open bite. Anterior downgraft is used for more tooth show. Both are CW rotations.
Sorry dude but you don't put all your info together correctly or all in one place. Case in point, Plosko tells you how CCW can work but you don't tell him you have a flat OP and anterior open bite or even show your ceph in this questioning process. You're just engaging people in a GUESSING GAME of what you MIGHT have. 'IF this THEN that'
Now you reveal you're not getting posterior impaction and want people to tell you how your surgeon is going to fix your open bite. I'll leave that to the PSYCHICS who can do 'remote reading' on exactly what your surgical plan says.
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Posterior impaction is a modality used to help close an open bite. Anterior downgraft is used for more tooth show. Both are CW rotations.
Sorry dude but you don't put all your info together correctly or all in one place. Case in point, Plosko tells you how CCW can work but you don't tell him you have a flat OP and anterior open bite or even show your ceph in this questioning process. You're just engaging people in a GUESSING GAME of what you MIGHT have. 'IF this THEN that'
Now you reveal you're not getting posterior impaction and want people to tell you how your surgeon is going to fix your open bite. I'll leave that to the PSYCHICS who can do 'remote reading' on exactly what your surgical plan says.
I am going to get clarification with my surgeon and hopefully he can email me his surgical plan. I spoke to my orthodontist and he said my surgeon will likely be impacting the upper posterior segments and leaving the anterior segment about where it is or extruding it - depending on my gum display.
I don’t know what extruding means. Maybe my surgeon just never felt he need to mention the impaction that will be done because it’s a given? Either way, I’ll find out soon.
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Why do you think my surgery will be bad? Now I’m doubting it. I don’t think my open bite is significant, so my new surgeon didn’t think it was an issue. I believe the impaction would be quite small if it was done.
Plosko isn't predicting your surgery will be bad. He's probably picking up on some
faulty information processing abilities. I mean it's not as if you demonstrate you understand how things work or even what you are getting. Nor do you convey all in one place what you even have.
He can correct me if I'm wrong. But I take it that he HOPES cheapness is not the main determining factor for your surgery. He's quite correct when he says: 'Bad surgery is worse than no surgery.' If you think he's predicting your surgery WILL be bad, then that demonstrates lack of processing abilities.
Look at one of your statements here where you said (in reference to chin wing):
......The thing is, you can always get an implant later if it truly is a worthless procedure.
I mean what kind of 'conclusion' is that in light that BenfromUK on here relays he had bad chin wing experience AFTER he got it to correct his bad implant experience. I'm wondering even if you understand the difference between a 'worthless procedure' and a BAD SURGERY necessitating much more pain expense, etc. than just slapping implants over it.
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Plosko isn't predicting your surgery will be bad. He's probably picking up on some
faulty information processing abilities. I mean it's not as if you demonstrate you understand how things work or even what you are getting. Nor do you convey all in one place what you even have.
He can correct me if I'm wrong. But I take it that he HOPES cheapness is not the main determining factor for your surgery. He's quite correct when he says: 'Bad surgery is worse than no surgery.' If you think he's predicting your surgery WILL be bad, then that demonstrates lack of processing abilities.
Look at one of your statements here where you said (in reference to chin wing):
I mean what kind of 'conclusion' is that in light that BenfromUK on here relays he had bad chin wing experience AFTER he got it to correct his bad implant experience. I'm wondering even if you understand the difference between a 'worthless procedure' and a BAD SURGERY necessitating much more pain expense, etc. than just slapping implants over it.
I’m assuming the bad CW result would be from a sub-par drop-down and/or widening that would be more enhanced with jaw implants. I mean worthless as in not overly noticeable result. I’ve seen b/a’s where that’s the case. There’s improvement but it’s “meh.” You’re right it could also be a bad procedure as in Ben’s case, but it seems to me the surgeon didn’t do what he was supposed to do, so his result isn’t indicative of what a side wing can normally achieve.
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I’m assuming the bad CW result would be from a sub-par drop-down and/or widening that would be more enhanced with jaw implants. I mean worthless as in not overly noticeable result. I’ve seen b/a’s where that’s the case. There’s improvement but it’s “meh.” You’re right it could also be a bad procedure as in Ben’s case, but it seems to me the surgeon didn’t do what he was supposed to do, so his result isn’t indicative of what a side wing can normally achieve.
A better assumption to make would be that Ben assumed a chin wing would be great for him based on SJ's content.
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A better assumption to make would be that Ben assumed a chin wing would be great for him based on SJ's content.
No we need to be clear about what went wrong in Ben’s case. As far as I understand from what Ben has told me (maybe I’m wrong or new information has been learned)) he communicated clearly to his surgeon he wanted a drop down in the back, the surgeon then went against this supposed plan and made the cut 3/4 way down his jaw and dropped down the front part of his jaw and chin, lengthening the wrong part of his face, making it look longer, squarish, and blunting the angles - when the problem as stated by him was at the BACK of his jaw, I.e his jaw angles. In other words, nothing was done at all to enhance his jaw angles.
His follow-up surgeon explained that the cut “should have been” from the back to about mid-way, dropping and widening the jaw angles and filling it with hip-grafts, leaving the chin area untouched. This was not done in Ben’s case. It seems to me he got a traditional chin wing for people who lack vertical hieight in the chin area, and NOT a side wing which is for those who have a high jaw angle.
So how can we conclude anything about the effects of a Side Wing from Ben’s case when it wasn’t it performed correctly ?
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No we need to be clear about what went wrong in Ben’s case. As far as I understand from what Ben has told me (maybe I’m wrong or new information has been learned)) he communicated clearly to his surgeon he wanted a drop down in the back, the surgeon then went against this supposed plan and made the cut 3/4 way down his jaw and dropped down the front part of his jaw and chin, lengthening the wrong part of his face, making it look longer, squarish, and blunting the angles - when the problem as stated by him was at the BACK of his jaw, I.e his jaw angles. In other words, nothing was done at all to enhance his jaw angles.
His follow-up surgeon explained that the cut “should have been” from the back to about mid-way, dropping and widening the jaw angles and filling it with hip-grafts, leaving the chin area untouched. This was not done in Ben’s case. It seems to me he got a traditional chin wing for people who lack vertical hieight in the chin area, and NOT a side wing which is for those who have a high jaw angle.
So how can we conclude anything about the effects of a Side Wing from Ben’s case when it wasn’t it performed correctly ?
Sorry dude but regarding BOTH SJ and Optimistic who you often cite for the chin wings it seems hard for you to conclude that BOTH got the chin wing FIRST and THEN the side wing. That is to say, both KNEW--and no problem understanding why-- one does a chin wing FIRST to CCW rotate the (back of )mandible downwards as to decrease the MP angle and THEN one does the side wing to 'pry out' the back part for the angles from the front effect. You seem to think that someone with a near high MP can just get ONLY a side wing which is not the case. Asking for it with a near high MP angle is like asking the doctor to have jaw angle sticking out right below your ears.
One makes the right conclusions by obtaining the right information and having the ability to process it which is what Optimistic did who had the ability to read and 'digest' med journal articles about the wings and also the ability to apply that info to himself. SJ being a fast learner, using same/similar information was able to do the same.
Now as to Ben, there is really no way for you to cross reference his case with cephs, before afters as to SEE the problem. What's clear to me is that he assumed a chin wing would work out well for him and assumed so via SJ's content and promotions of them.
Even Dr. Z is trying to spare you from making the wrong decision and you still don't get it. Maybe Ben's doctor will do it for you.
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Now as to Ben, there is really no way for you to cross reference his case with cephs, before afters as to SEE the problem. What's clear to me is that he assumed a chin wing would work out well for him and assumed so via SJ's content and promotions of them.
Even Dr. Z is trying to spare you from making the wrong decision and you still don't get it. Maybe Ben's doctor will do it for you.
Lol I already told you what the problem was. There is nothing more to see. Ben went to another surgeon who took Cephs and pinpointed why the surgery gave a bad result. There is no need to be vague and say we have no way of knowing. That’s already been figured out. He assumed a chin wing would work out well for him given that the drop down would be at the back, not the front. SJ obviously got a drop down at the back, same with Optimisitc, Ben did not.
Is it not clear to you that the problem has less to do with SJs promotion of the CW or Optimisitc’s awesome information processing abilities and more to do with the fact that Ben’s surgeon messed up? That’s the point I am trying to convey here.
Ben got the majority of his money back. I may be wrong but is that even possible to do if the CORRECT procedure was performed and the patient just happened to be dissatisfied? That’s probably only going to happen if the surgeon admits he did something extraneous, wrong, out of the ordinary, unexpected etc. So that is proof that there is more to the story here.
You seem to want to muddy my point in an effort to dismiss the CW procedure altogether.
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Lol I already told you what the problem was. There is nothing more to see. Ben went to another surgeon who took Cephs and pinpointed why the surgery gave a bad result. There is no need to be vague and say we have no way of knowing. That’s already been figured out. He assumed a chin wing would work out well for him given that the drop down would be at the back, not the front. SJ obviously got a drop down at the back, same with Optimisitc, Ben did not.
Is it not clear to you that the problem has less to do with SJs promotion of the CW or Optimisitc’s awesome information processing abilities and more to do with the fact that Ben’s surgeon messed up? That’s the point I am trying to convey here.
Ben got the majority of his money back. I may be wrong but is that even possible to do if the CORRECT procedure was performed and the patient just happened to be dissatisfied? That’s probably only going to happen if the surgeon admits he did something extraneous, wrong, out of the ordinary, unexpected etc. So that is proof that there is more to the story here.
You seem to want to muddy my point in an effort to dismiss the CW procedure altogether.
You muddy your own points. Some examples of your other conclusions:
Some of your other conclusions:
That may be true but consider that he underwent a side wing that vertically dropped his ramus for the sole purpose of squaring his jaw,
No, it's the chin wing that vertically drops the BORDER of the mandible and in his (SJ's) case to make LESS the MP. The side wing, AFTER THAT is used to square out the jaw.
...... My jawline is steep but not severely so, so implants or CW could fix that no problem.
This after you're told having a standard BSSO cut IS a problem with a chin wing?
..... I actually don’t even want a CW but a side wing.
Same as saying you only want the second step of something that's contingent on the first step being done. For a side wing not to stick up close to the ears in someone who is NOT a LOW MP angle patient, one FIRST needs the CW to rotate and drop down the border of the mandible.
Visually speaking I’m not sure why a BSSO would make a side wing harder, chin wing yeah I can understand because you’re cutting further down where the BSSO cut was made, which is probably what he means by “the border is destroyed with BSSO,” but with SW the cut is at the back only, I.e there’s no sliding forward movement or anterior mandible dropdown needed in my case as that will be accomplished with my genio and BSSO. I just want a wider, squarer jaw at the back
So, exercise in futility to provide visuals. A cut from the front needs to be done to get to the back.
I guess the next thing to determine is why some BSSO cuts are preferred to others and why. Is it arbitrary? Does it depend on the surgeon?
Dr. Z told you why and ample visual info was provided on the board to this regard.
This was Dr. Z’s explanation.....
“if the distance after conventional BSSO from the lower border to the nerve is too small Side Wing or Chin Wing are not possible anymore. And: Small segment (makes for ?) difficult fixation, higher risk of resorption, possible step in Jaw Line.”
The latter part I think was in response to me asking if he could segment only a small part of the back jaw for the side wing. So it seems the real issue is the distance from lower border to nerve? But isn’t that the case even if you don’t get a BSSO? I’m confused.
Only a small segment can be moved in either chin wing or side wing if the lower border of the mandible is too close to the nerve. But to do a side wing on a near high angle patient, one needs the chin wing first to lower the angle and then the side wing. No small segments even with no BSSO.
You got ruined goinal angles because the surgeon segmented the wrong section of your mandible. Hard to believe, but he messed up. CW is going to blunt your angels but a side wing should not. How could it ?
CW only blunts the angles if the angles have to be brought forward in the act of advancing the chin. If the movement is just a downward drop with CCW rotation to the back of the mandible, there is no blunting. If there is blunting of the angles when the whole chin wing segment is advanced forward to include chin advancment, a SECOND operation is done to move the part of the angle back, pry it outward for a side wing and also put a bone BUTRESS between the GAP doing that makes. It is not a thing of 'just getting a side wing ONLY'.
There is a user here, Optimistic, that apparently had great results with a side wing.
That user got both the chin wing and the side wing as the second operation and he had NO BSSO. I attribute his success to his having a good ability to PROCESS INFORMATION (he's smart) and having the ability to apply it to himself correctly to make the right decision. He was able to FIGURE OUT all of the above with little help from others and did it without confusion and faulty conclusions.
If after all that you still don't understand why you just can't have a 'side wing', I GIVE up and I shall leave you to your own devices to figure out for yourself what will work for you and what won't.
Be my guest and conclude as you like about Ben and disregard SJ's stuff factored into to his being attracted to getting a chin wing. I'm NOT 'dismissing' the CW procedure altogether. I just think that people who actually UNDERSTAND how it works are the best candidates for it.
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Ok I was misusing the term side wing. I thought a chin wing was to advance the chin and/or vertically lower it, and a side wing dropped down the jaw angles. If a side wing only widens the angles, I may not even need that. What I need most importantly is to drop the angles, achieved with a chin wing.
I’ve been avoiding the term “chin wing” because I thought that would be what Ben had done which dropped the chin and middle jaw, hence my wrong usage of side wing. I wanted to differentiate between dropping down the front part of jaw and the back.
Optimisitc was ecstatic with his results from the first chin wing BEFORE he went for the side wing... so in his case dropping the jaw angles alone gave a great improvement.
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Look at the attached image. There are users who have contacted Dr. Z who told them himself that a side wing is a procedure to lengthen and widen the jaw angles without touching the chin. That’s exactly how I was using the term.
So take it easy there Kavan, you didn’t have to go full blown autism on me because I may - or may not - have been misusing terms.
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Look at the attached image. There are users who have contacted Dr. Z who told them himself that a side wing is a procedure to lengthen and widen the jaw angles without touching the chin. That’s exactly how I was using the term.
So take it easy there Kavan, you didn’t have to go full blown autism on me because I may - or may not - have been misusing terms.
Congratulations. You found one of SJ's aliases.
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Ok I was misusing the term side wing. I thought a chin wing was to advance the chin and/or vertically lower it, and a side wing dropped down the jaw angles. If a side wing only widens the angles, I may not even need that. What I need most importantly is to drop the angles, achieved with a chin wing.
I’ve been avoiding the term “chin wing” because I thought that would be what Ben had done which dropped the chin and middle jaw, hence my wrong usage of side wing. I wanted to differentiate between dropping down the front part of jaw and the back.
Optimistic was ecstatic with his results from the first chin wing BEFORE he went for the side wing... so in his case dropping the jaw angles alone gave a great improvement.
Both Optimistic and SJ had the chin wing first and then the side wing. One to drop down. The other to wing outwards so the angles show from the front. There are different variations of how they can move parts of the lower border of the mandible. A 'chin wing' just refers to the act of being able to cut along the border of the mandible and move things in different directions without doing a BSSO. You have to study diagrams to visualize the different ways.
Well, if Optimistic was ecstatic with his results BEFORE he went for the side wing, it should follow that he got the chin wing FIRST.
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Both Optimistic and SJ had the chin wing first and then the side wing. One to drop down. The other to wing outwards so the angles show from the front. There are different variations of how they can move parts of the lower border of the mandible. A 'chin wing' just refers to the act of being able to cut along the border of the mandible and move things in different directions without doing a BSSO. You have to study diagrams to visualize the different ways.
Well, if Optimistic was ecstatic with his results BEFORE he went for the side wing, it should follow that he got the chin wing FIRST.
Yes the confusion here is that you thought I wanted the side wing (flared angles) first without dropping them vertically - obviously that would be a disaster.
I propose that the term ‘wing’ refers to the cutting along the border, where “chin wing” means dropping or advancing the chin, as in class II patients who want camaflouge work instead of JS, “Side Wing” where the jaw angles are flared laterally, and “jaw wing” or “back wing” where the jaw angles are lengthened vertically, because everyone has a different interpretation of chin wing.
I mean can you imagine if Ben’s surgeon dropped his chin and middle jaw area simply because Ben asked for a chin wing, meanwhile Ben thought a chin wing meant dropping the back jaw? Just horrendous, unacceptable miscommunication if that’s the case. This is why I’m paranoid about not using “chin wing”
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Since you guys are in the thick of this discussion about chinwings I just wanted to ask: Is it possible to get bimax AFTER a chin wing/side wing or would that be in the way of bimax? or bsso? Just curious.
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Yes the confusion here is that you thought I wanted the side wing (flared angles) first without dropping them vertically - obviously that would be a disaster.
I propose that the term ‘wing’ refers to the cutting along the border, where “chin wing” means dropping or advancing the chin, as in class II patients who want camaflouge work instead of JS, “Side Wing” where the jaw angles are flared laterally, and “jaw wing” or “back wing” where the jaw angles are lengthened vertically, because everyone has a different interpretation of chin wing.
I mean can you imagine if Ben’s surgeon dropped his chin and middle jaw area simply because Ben asked for a chin wing, meanwhile Ben thought a chin wing meant dropping the back jaw? Just horrendous, unacceptable miscommunication if that’s the case. This is why I’m paranoid about not using “chin wing”
There is no confusion. I 'thought' so because your WORDS said you wanted just the side wing. It's only obvious to you now because I had to break it down FOR you.
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Since you guys are in the thick of this discussion about chinwings I just wanted to ask: Is it possible to get bimax AFTER a chin wing/side wing or would that be in the way of bimax? or bsso? Just curious.
I don't know. Ask the graduate of the Midvale School for the Gifted.
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There is no confusion. I 'thought' so because your WORDS said you wanted just the side wing. It's only obvious to you now because I had to break it down FOR you.
Jesus Kavan Side Wing refers to jaw angle widening and/or lengthening, as per Z himself. Chin wing refers specifically to the chin area. Everyone but you in this thread knew that I meant jaw angle lengthening. You didn’t break down anything for me.
After reviewing emails with Z, he uses side wing to refer to back of the jaw. You’re the one misusing the term.
I can’t believe I’m even wasting energy on such petty nonsense.
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Enough already from you because I told you already side wing refers to back of jaw. The waste of energy is MUTUAL. In the interest of energy conservation, I'm locking this thread.