jawsurgeryforums.com
General Category => Aesthetics => Topic started by: Sajua on July 26, 2019, 08:15:29 AM
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Hello everyone,
thanks a lot for looking into my post. I am a female in my 30ies and I really need some advice, as I don't know what to do.
The cephs attached were taken before and 6 months after BSSO surgery (was performed due to functional issues). The upper jaw was not touched. The surgery went well and braces are supposed to be taken off this summer. However, I am still not sure if having only single-jaw surgery was the right decision. I feel like I am lacking bone support in my upper jaw as well which starts to show more as I am aging.
I would be very happy to hear your opinion about that, cause I have been having this topic on my mind for a while now, and I am also getting mixed opinions on it from the surgeons I've consulted.
thanks for your help
Sajua
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Based on the soft tissue profiles in the CEPHs it looks like you got a nice improvement overall. Maxillary advancement carries some serious aesthetic risks, especially for women. I think you might have tolerated it well given the dimensions of your nose/lip, but there’s also a chance it could have come out much worse.
If your bite is good, any revision would have to be a bimax. I can’t say I’d recommend it in your case based on those pictures, but maybe we need to see more angles.
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You look great! I don't think you need anything more done. Your profile lines up perfectly and you have a good (short) philtrum with nice lips.
What are the surgeons saying?
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You look fine.
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Need to see more records than those to know.
From what you posted, you look good and should move on with life.
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Nothing has the potential to make one uglier than an inappropriate maxillary surgery. You look great. If your functional issues have been solved and you have no nerve damage, you've made out like a bandit.
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Yep. "Upper surgery not needed" would be music to most ears.
You get to keep your nose and not risk all the aesthetic downside.
Moving your upper jaw around is not going to have much, if any, effect on your skin. If it's lacking support due to age it's likely the skin itself losing elasticity and collegen. You're in your 30s and that's what happens to everyone except people with great skin. Don't be dumb and have jaw surgery for that.
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Hello everybody!
Many thanks to all of you for your helpful feedback which I really appreciate!
The opinions of the surgeons vary, as some of them say nothing is needed and two of them advised me of doing single upper jaw surgery.
the suggested plan is the following: advancing upper jaw vertically by about 2mm and downgrafting it by about 3mm, as I have almost no upper tooth show. Hence, the whole jaw will be rotated. Right now my upper teeth are also very flared outwards as I have a small jaw, and rotating the upper jaw is supposed to help this issue as well. as this would make my chin retruded (which already kinda is) some kind of chin enhancement would be needed (genioplaty, implant or HA-paste).
according to the doctor, upper jaw surgery does not come with as many risks as lower jaw surgery. However, the reviews on that are very mixed and I would like to hear your guys' opinions as well.
Moreover, I've also read that the jaw tends to decrease in volume with age which also worries me, as I already have a small jaw.
Attached you find two pics that show also my face in proportion. Could it be that both my jaws are retruded, and I would ideally need bimax? My paranasal area is quite flat, so that is one of the reasons i am asking.
Many thanks again for your help.
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I think that what you 'need' is to realize you already look pretty good.
Surgery advice and/or encouragement for pursuit...DECLINED.
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I don't think you need anything.
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You don’t need surgery. Shame on the surgeons proposing procedures on you.
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I also dont have any upper tooth show at all which is really bothering me, hence i was suggested that plan.
I would be happy to hear if that plan would be feasible or if it would make things worse. And also how it would affect my lips.
Is upper jaw surgery related to many risks?
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I don't think there is something wrong with your facial structure, based on these pics. Maybe your nose from the front isn't the best, but I have to see better pics.
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Having jaw surgery is ultimately something you decide. Something that looks minor can be a big issue to someone else, jada jada.
Base on what I read you have no medical issues and it's a pure aesthetic concern. Your bite was corrected and you don't mention anything about airways. One important thing to understand about jaw surgery is that it alters your bite, and there's always a risk they don't get it right. For most people having jaw surgery that's a minor risk, because they go in with a malocclusion. Trying to fix something that is broken is necessary, while fixing something that is not, takes some balls.
Your aesthetic concern doesn't seem very established. You're not sure if lower jaw surgery was the right decission so you go consulting and get some proposals and we later get some concerns about tooth show. Tooth show is a concern that can be adressed with jaw surgery if it's a real concern. But you understand it makes little sense when you present your situation with profile photos and ask if you should have surgery for your consern about tooth show. You will get comments on what can be seen on the pictures you show.
Your surgical plan is not clear to understand at least for me. "advancing upper jaw vertically by about 2mm and downgrafting it by about 3mm". Vertical adjustments are normally not denoted as advancements, I can't read what these mm mean and how it's actually displaced. You talk about rotation and flaring teeth inwards, so probably clockwise rotation. If you already have a good bite, and you're doing only upper jaw surgery, it needs to be done in a way to maintain the bite.
You've been told upper jaw surgery is a minor surgery compared to lower jaw surgery. There's no way to meassure such thing, it's different fractures. I can tell you, lower jaw surgery is sometimes done under local anaesthesia, which upper jaw surgery is not. Go to youtube and watch some videos of "lefort I surgery" and "bsso surgery" and come back and tell us what you think is minor and major.
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Maybe your nose from the front isn't the best, but I have to see better pics.
What? Her nose is objectively fine.
Don't listen to people who are unhappy with their own issues and project it on to you.
Give zero weight to those types of comments.
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I also dont have any upper tooth show at all which is really bothering me, hence i was suggested that plan.
I would be happy to hear if that plan would be feasible or if it would make things worse. And also how it would affect my lips.
Is upper jaw surgery related to many risks?
..advancing upper jaw vertically by about 2mm and downgrafting it by about 3mm, as I have almost no upper tooth show. Hence, the whole jaw will be rotated. Right now my upper teeth are also very flared outwards as I have a small jaw, and rotating the upper jaw is supposed to help this issue as well. as this would make my chin retruded (which already kinda is) some kind of chin enhancement would be needed (genioplaty, implant or HA-paste).
You're relaying a plan that advances the upper jaw not forward but'VERTICALLY' where this plan will make your chin retruded such that you would also need chin advancement to have it and you want feedback as to it's relationship to your TOOTH SHOW when you elected to show photos with your mouth CLOSED.
It's like this: If you have to be told that advancements are forward and not 'vertical' and that photos with mouth closed aren't a good reference point to ask about plans involving not only surgery to one area but also to another area (because the proposal makes the other area worse), that's not a 'go ahead' to give detailed feedback about this plan other than to tell you to stay as you are.
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Kavan, is it only me, or can you understand what the proposed displacement is?
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Kavan, is it only me, or can you understand what the proposed displacement is?
I understand that she doesn't relay information correctly for the advice she's wanting. For example, advancements are expressed as FORWARD and not vertical.
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What? Her nose is objectively fine.
Don't listen to people who are unhappy with their own issues and project it on to you.
Give zero weight to those types of comments.
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I literally have no idea what he’s seeing there besides actively trying to induce bdd.
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Kavan, is it only me, or can you understand what the proposed displacement is?
It sounds like CW rotation with advancement 2mm, downgraft 3mm and she just mistakenly used the word vertically instead of horizontally.
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I literally have no idea what he’s seeing there besides actively trying to induce bdd.
toxic :-\
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It sounds like CW rotation with advancement 2mm, downgraft 3mm and she just mistakenly used the word vertically instead of horizontally.
toxic :-\
That would have to be anterior downgrafting to get the rotation then. It seems like a vague plan, wonder if there was proper planning to see what is actually possible to maintain the bite with only upper jaw surgery.
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That would have to be anterior downgrafting to get the rotation then. It seems like a vague plan, wonder if there was proper planning to see what is actually possible to maintain the bite with only upper jaw surgery.
CORRECT!
It's not a good plan and has caveat of; 'Be careful of what you ask for'
The amount of tooth show below the red line will be the amount that shows when the lips are slightly open and will show more with a smile. So, it's not a thing of lack of tooth show, or 'no tooth show' as she says.
Clockwise rotation to get more tooth show is not a good solution in this case because it's going to 'push back' on the lower jaw to make it look more recessive thereby necessitating chin advancement/augmentation to COMPENSATE for the lower jaw retrusion it would create and nobody knows what some hypothetical chin implant would look like on her or if she will be happy with the gain of a few mm extra tooth show at the cost of ALTERING the EQUILIBRIUM of the past surgery that already looks good. Advancement can also straighten out the curl to the upper lip which can make it look longer in frontal view because the curve that gives a nice shortness to it is being pushed on.
So, it's not a good plan if she likes how her lips look and how her lower jaw looks now. Only if she wants to trade those things in for some undefined and 'different' look in exchange for a few extra mm of tooth show.
Diagrams enclosed in this post.