jawsurgeryforums.com
General Category => Aesthetics => Topic started by: IconVillage on August 15, 2019, 08:43:00 PM
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Dr. Eppley states:
What creates an outer facial appearance is the shape of the implant that lies underneath. What composition facial implants are made of makes no difference at all. So that is a misconception.
https://www.eppleyplasticsurgery.com/is-medpor-or-silicone-facial-implants-better/
Is this true? I've been adverse to silicone jaw implants as they look to "puffy," "shiny" and "plastic," but if there is really no difference then is it worth it to pay more for Medpor, PEEK or Titanium if the aesthetic result is dependent on the design and not the material?
Conversely, Dr. Ramirez states:
Medpor gives a sharper and more defined look. It also produces minimal or none bone erosion. Silicone produces significant bone erosion particularly under the pressure of the strong masseter muscle. I will send you a rough draft explaining this and other comparative features
While Dr. van de Ven states:
Another disadvantage of the silicone implant is the unnatural look it mostly gives, if not at the beginning then after a few years when the body of the patient reacts by forming a capsule around the facial implants. The capsule will contract with time and the look becomes more and more unnatural. The unnatural look is the reason why lots of patients have their silicone chin implant removed after a few years. As facial implants, silicone implants are simply not suited.
So what is the truth here?
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Oh no. The shape of the implant would have nothing to do with how it looks in your face. Let's see if you can figure out if what I said is true or false.
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Oh no. The shape of the implant would have nothing to do with how it looks in your face. Let's see if you can figure out if what I said is true or false.
I'm merely asking if the exact same 3D custom design was used in the case of Silicone, Medpor, PEEK and Titanium, would the aesthetic result yield the same outcome? Eppley seems to say yes, while Ramirez believes Medpor provides more angularity.
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I'm merely asking if the exact same 3D custom design was used in the case of Silicone, Medpor, PEEK and Titanium, would the aesthetic result yield the same outcome? Eppley seems to say yes, while Ramirez believes Medpor provides more angularity.
More like it that you're demonstrating that you can't think for yourself as to something that should be intuitively obvious and need to be spoon fed.
Have you figured out yet whether my prior statement was true or false? In the mean time, I'm going to leave it a mystery whether or not Eppley's statement is true or whether or not my statement is true or false.
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Of course Eppley is going to say 'it makes no difference'. He hasn't been allowed to use materials like peek until recently. Eppley is the typical business scammer. s**tty results for low price. He loves silicone: easy to take out when something goes wrong. And oh boy, does it go wrong alot of times in his cases.
The shape of the implant plays a role as well. But solicone usually looks a bit more unnatural due to the smoothness of the surface. It also has a tendency to make the screws loose long term due to its softness.
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Of course Eppley is going to say 'it makes no difference'. He hasn't been allowed to use materials like peek until recently. Eppley is the typical business scammer. s**tty results for low price. He loves silicone: easy to take out when something goes wrong. And oh boy, does it go wrong alot of times in his cases.
The shape of the implant plays a role as well. But solicone usually looks a bit more unnatural due to the smoothness of the surface. It also has a tendency to make the screws loose long term due to its softness.
Yes, that is what I was thinking, his insistence on silicone seems to be ease of access and his monopolization of the custom implant business in the US which probably allows for some rapport with silicone manufacturers.
However, I think Eppley has some aesthetic eye for producing dramatic, angular results with silicone, but a lot of the time he goes overboard. I have seen some PEEK results with Joel DeFrancq but I didn't notice much of an aesthetic improvement over silicone, or any aesthetic improvement at all. For example, here's a DeFrancq result that didn't produce any angularity and still lends itself to that bloated silicone look:
(https://www.facialsculptureclinic.com/assets/cases/9536258181/Dr-Joel-Defrancq-1517302733083603600_4637.jpg)
So far, the best jaw implant results I've seen have come from Dr. Terino (who I believe is retired or extremely old), Dr. Yaremchuk and Dr. Eppley, with the later 2 also having some terrible results and bad reviews as well, but all use silicone.
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Of course Eppley is going to say 'it makes no difference'. He hasn't been allowed to use materials like peek until recently. Eppley is the typical business scammer. s**tty results for low price. He loves silicone: easy to take out when something goes wrong. And oh boy, does it go wrong alot of times in his cases.
The shape of the implant plays a role as well. But solicone usually looks a bit more unnatural due to the smoothness of the surface. It also has a tendency to make the screws loose long term due to its softness.
It doesn't make much to any any difference. It's the SHAPE of the implant that gives the face shape. When docs talk about which material is better, the reference point is NOT about a custom implant of the SAME shape vs different materials of that same shape. It's about off shelf ones where they are not all same shape. Any material can look unnatural if it's the wrong shape for your face. I'm surprised you didn't get that one.
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Yes, that is what I was thinking, his insistence on silicone seems to be ease of access and his monopolization of the custom implant business in the US which probably allows for some rapport with silicone manufacturers.
However, I think Eppley has some aesthetic eye for producing dramatic, angular results with silicone, but a lot of the time he goes overboard. I have seen some PEEK results with Joel DeFrancq but I didn't notice much of an aesthetic improvement over silicone, or any aesthetic improvement at all. For example, here's a DeFrancq result that didn't produce any angularity and still lends itself to that bloated silicone look:
So far, the best jaw implant results I've seen have come from Dr. Terino (who I believe is retired or extremely old), Dr. Yaremchuk and Dr. Eppley, with the later 2 also having some terrible results and bad reviews as well, but all use silicone.
Eppley and sometimes Y get a lot of BLOCK HEADs where the looks they want accommodated are extreme. Little to do with the material and more to do with accommodating requests of 'I want what the model has' which doesn't look good on the requester. It's just easier to put in piece of squeezable silicone in to accommodate an uncanny valley request from a dummy than doing it with a hard material that can't be folded into the incision.
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Yes, that is what I was thinking, his insistence on silicone seems to be ease of access and his monopolization of the custom implant business in the US which probably allows for some rapport with silicone manufacturers.
However, I think Eppley has some aesthetic eye for producing dramatic, angular results with silicone, but a lot of the time he goes overboard. I have seen some PEEK results with Joel DeFrancq but I didn't notice much of an aesthetic improvement over silicone, or any aesthetic improvement at all. For example, here's a DeFrancq result that didn't produce any angularity and still lends itself to that bloated silicone look:
(https://www.facialsculptureclinic.com/assets/cases/9536258181/Dr-Joel-Defrancq-1517302733083603600_4637.jpg)
So far, the best jaw implant results I've seen have come from Dr. Terino (who I believe is retired or extremely old), Dr. Yaremchuk and Dr. Eppley, with the later 2 also having some terrible results and bad reviews as well, but all use silicone.
This is not bloated silicone look and has nothing to do with the material. This has all to do with the dissappearance of the ogee line. I guarantee you that if you morph the first pic with the same width as the second, you'll get a better result. Why? Because with morphing, you'll only morph the lower part of the jaw and the ogee line is preserved. The ogee line probably dissappeared because of the fact the implant goes up under the masseter muscle, pushing the masseter muscle outwards, making the hollowing of the cheek dissapear. The implant goes up underneath the masseter, and this is often needed to fixate the implant, but it's in many cases problematic cause you only need the implant at the lower boarder of the jaw. That's why some filler results do give the needed angularity, due to the fact they only target the lower part of the jaw. But take a look at almost all implant designs. You see parts that aren't needed aestethically. The ogee line must be preserved, or else you get a bloated look and you lose the subtility in the face. The bigger the implant, the more chances of ruining the ogee line. Unfortunately, the ogee line is very underrated.
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I morphed the first guy, preserving the ogee line:
But you could question his decision to get an implant in the first place: did he really need an implant?
For some people this procedure is really really a matter of millimeters. One or two millimeters too much or at the wrong places, and you simply go down half a point or sometimes more than one point on the looks scale. Every implant material that isn't needed in one part of the face, should not be there.
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The ogee line refers to the CHEEK CURVE from oblique view. It's not a curve that refers to frontal perspective.
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The ogee line refers to the CHEEK CURVE from oblique view. It's not a curve that refers to frontal perspective.
Then I don't know how to call that area underneath the cheekbones where the shadows of the face are, to the back. This area must not 'pop out' too much. That's the risk of (big) implants.
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Then I don't know how to call that area underneath the cheekbones where the shadows of the face are, to the back. This area must not 'pop out' too much. That's the risk of (big) implants.
Area below cheek bone prominence is referred to as 'submalar' or simply; 'below the cheeks'. If it's a matter of wanting to describe an area between the cheeks and jaw bone, it can be referred to in those simple words. Add 'hollow in between' if that's what you mean. It is quite possible to articulate what one is seeing in the absence of (in)correct terminology.
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Spoke to a max-fac surgeon who uses Titanium implants and he says he prefers them to PEEK as they are more "precise." Interesting.
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titan biggest advantage is having a certain resistance to infection, because infection can mean having to lose the whole implant. titan has proven succesful in other areas of medical surgery
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Yes total femur replacements are done with titanium. Although they have a very low success rate.
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CLUE:
The SAME SHAPE of something can be made from a variety of materials.
If I sculpt something with wax, put it in a cast, melt out the wax and pour in molten bronze, the bronze shape will be SAME as the wax shape I put in there. I could fill it with Jello too and it would come out the same SHAPE.
The material I use does NOT change the SHAPE of my sculpture. Material comes into play depending what I want to do with the sculpture, give one one away as a gift or eat the other one.
CLUE: A designer dress looks better on a model than does a burlap bag. But the burlap bag is stronger material (or better material). What's more important..the design or the material?
For those still clueless as to how that concept relates to the context of what Eppley is saying, the real question is the one you've gotta ask yourself such as: 'Am I in the capacity to conceptually 'digest' anything a doctor tells me?'
Better check yourself before you wreck yourself.
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CLUE:
The SAME SHAPE of something can be made from a variety of materials.
If I sculpt something with wax, put it in a cast, melt out the wax and pour in molten bronze, the bronze shape will be SAME as the wax shape I put in there. I could fill it with Jello too and it would come out the same SHAPE.
The material I use does NOT change the SHAPE of my sculpture. Material comes into play depending what I want to do with the sculpture, give one one away as a gift or eat the other one.
CLUE: A designer dress looks better on a model than does a burlap bag. But the burlap bag is stronger material (or better material). What's more important..the design or the material?
For those still clueless as to how that concept relates to the context of what Eppley is saying, the real question is the one you've gotta ask yourself such as: 'Am I in the capacity to conceptually 'digest' anything a doctor tells me?'
Better check yourself before you wreck yourself.
Shape is one thing. Other things do play a role as well. The roughness of the surface versus smoothness for example. Peek is rougher than silicone. Skin sticks less on silicone because of this. If a material is porous or not plays a role as well. Porous implants allow for tissue ingrowth.
I had both silicone and Peek and I think Peek looks more natural. I do agree that the shape of the implant plays the most important role. It also depends on someone's face. Some faces can take up silicone, others nit so much.
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Shape is one thing. Other things do play a role as well. The roughness of the surface versus smoothness for example. Peek is rougher than silicone. Skin sticks less on silicone because of this. If a material is porous or not plays a role as well. Porous implants allow for tissue ingrowth.
I had both silicone and Peek and I think Peek looks more natural. I do agree that the shape of the implant plays the most important role. It also depends on someone's face. Some faces can take up silicone, others nit so much.
Well, ya that's a point here. But the other point is that material is a secondary consideration. For example for all materials that make the SAME SHAPE, are you so sure the design is going to be what you want to see in the mirror that you wouldn't want it removed, then you can choose something with tissue ingrowth over silicone OR if you don't mind a LARGER incision to place a titanium implant (which can't be folded and placed through a smaller one like silicone), then choose titanium. This refers to CUSTOM implants of SAME SHAPE.
By the way, skin does not 'stick' to ANY implant, silicone or other. Implants are placed to subperiosteal plane which is well below any direct contact with the skin.
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Well, ya that's a point here. But the other point is that material is a secondary consideration. For example for all materials that make the SAME SHAPE, are you so sure the design is going to be what you want to see in the mirror that you wouldn't want it removed, then you can choose something with tissue ingrowth over silicone OR if you don't mind a LARGER incision to place a titanium implant (which can't be folded and placed through a smaller one like silicone), then choose titanium. This refers to CUSTOM implants of SAME SHAPE.
By the way, skin does not 'stick' to ANY implant, silicone or other. Implants are placed to subperiosteal plane which is well below any direct contact with the skin.
Yeah you're right. I meant the tissue.
But yeah, shape is most important. If the shape is too big or doesn't fit the underlying bone structure, one might get unnatural looking results.
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Well, ya that's a point here. But the other point is that material is a secondary consideration. For example for all materials that make the SAME SHAPE, are you so sure the design is going to be what you want to see in the mirror that you wouldn't want it removed, then you can choose something with tissue ingrowth over silicone OR if you don't mind a LARGER incision to place a titanium implant (which can't be folded and placed through a smaller one like silicone), then choose titanium. This refers to CUSTOM implants of SAME SHAPE.
By the way, skin does not 'stick' to ANY implant, silicone or other. Implants are placed to subperiosteal plane which is well below any direct contact with the skin.
What do you think of this result: https://imgur.com/a/bjkdr
You can find more context here: https://www.reddit.com/r/PlasticSurgery/comments/7z5u5m/i_got_silicone_chin_and_jaw_implants_2_weeks_post/
Personally I think it looks great, but with implants I would always fear that they can get infected or even show trough the flesh which isn't uncommon.
To put the price point of $10k into perspective, for that kind of money you can either get a small used car or a surgery which changes your social, professional and love life forever.
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What do you think of this result: https://imgur.com/a/bjkdr
You can find more context here: https://www.reddit.com/r/PlasticSurgery/comments/7z5u5m/i_got_silicone_chin_and_jaw_implants_2_weeks_post/
Personally I think it looks great, but with implants I would always fear that they can get infected or even show trough the flesh which isn't uncommon.
To put the price point of $10k into perspective, for that kind of money you can either get a small used car or a surgery which changes your social, professional and love life forever.
ehhh...it's ok and clearly the guy is happy with it. So, his liking it is going to be more important than my opinion on it is. Also, keep in mind you're asking someone, me, who can spot stuff that the average onlooker won't be looking for.
That said, to my eye, his class 2 skeletal pattern of recessive jaw, in particular, his lower lip being BEHIND his upper lip, is still visible despite his trying to compensate for jaw recession which is done by making his chin more prominent in both projection and length. Although the jaw implant aspect of it can augment laterally and down to beef up the back part, the one direction no jaw implant can reproduce is bringing the mandible forward (lips go with that when BSSO brings mandible forward). Hence the OVER COMPENSATION to the chin.
Again, I see things others don't and what I see is jaw recession masked by the over compensation to the chin. But I realize that's what they GOTTA do when people want to hide the jaw recession that way.
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What do you think of this result: https://imgur.com/a/bjkdr
You can find more context here: https://www.reddit.com/r/PlasticSurgery/comments/7z5u5m/i_got_silicone_chin_and_jaw_implants_2_weeks_post/
Personally I think it looks great, but with implants I would always fear that they can get infected or even show trough the flesh which isn't uncommon.
To put the price point of $10k into perspective, for that kind of money you can either get a small used car or a surgery which changes your social, professional and love life forever.
Yeah like Kavan said, chin looks a little bit too much but it's much better than before. I personally would have made it a little less long, but some American surgeons like it big. He had very recessed chin.
He has other flaws like philtrum, but the facial structure is better than before. Infection of chin implant is highly unlikely, especially when it's done through the exterior.
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ehhh...it's ok and clearly the guy is happy with it. So, his liking it is going to be more important than my opinion on it is. Also, keep in mind you're asking someone, me, who can spot stuff that the average onlooker won't be looking for.
That said, to my eye, his class 2 skeletal pattern of recessive jaw, in particular, his lower lip being BEHIND his upper lip, is still visible despite his trying to compensate for jaw recession which is done by making his chin more prominent in both projection and length. Although the jaw implant aspect of it can augment laterally and down to beef up the back part, the one direction no jaw implant can reproduce is bringing the mandible forward (lips go with that when BSSO brings mandible forward). Hence the OVER COMPENSATION to the chin.
Again, I see things others don't and what I see is jaw recession masked by the over compensation to the chin. But I realize that's what they GOTTA do when people want to hide the jaw recession that way.
How should the lips ideally be positioned? My lower lip was in front of my upper pre-op but now my upper is several MMs more forward than my lower post-op.
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How should the lips ideally be positioned? My lower lip was in front of my upper pre-op but now my upper is several MMs more forward than my lower post-op.
I gotta make this short as verbally describing 'ideals' takes a lot of time ....Not the way the guy's are in that photo where his lower lip is that much behind. In general the lips should look like they line up.
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I gotta make this short as verbally describing 'ideals' takes a lot of time ....Not the way the guy's are in that photo where his lower lip is that much behind. In general the lips should look like they line up.
Yeah I mainly just meant ‘ideal’ relationship with respect to the A-P plane, thank you. My upper lip vermillion projects a few MMS anteriorly more than my lower, which is the opposite of my pre-op. I’m guessing this is due to the somewhat clockwise movement which was compensated with a genioplasty. That seems to put me in a similar position as the guy in the photo which is why I asked.
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Yeah I mainly just meant ‘ideal’ relationship with respect to the A-P plane, thank you. My upper lip vermillion projects a few MMS anteriorly more than my lower, which is the opposite of my pre-op. I’m guessing this is due to the somewhat clockwise movement which was compensated with a genioplasty. That seems to put me in a similar position as the guy in the photo which is why I asked.
Thing is, my response was in reference to being asked about someone's implants and photos of which where the question was within the scope of the general topic of the thread; SHAPE of IMPLANTS. Something where my observations were within the context of applying to the topic matter at hand.
Your question not only required a SHIFT in SCOPE to address but also for me to draft up a doctrine in 'ideal' lip relationships as to be directly applicable to your own specifics, (which have nothing to do with the shape of implants) whereas I KNOW I've ALREADY targeted focus on your lip situation. It has nothing to do with 'lip line up' but rather contour irregularity to the labial ledge.
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Thing is, my response was in reference to being asked about someone's implants and photos of which where the question was within the scope of the general topic of the thread; SHAPE of IMPLANTS. Something where my observations were within the context of applying to the topic matter at hand.
Your question not only required a SHIFT in SCOPE to address but also for me to draft up a doctrine in 'ideal' lip relationships as to be directly applicable to your own specifics, (which have nothing to do with the shape of implants) whereas I KNOW I've ALREADY targeted focus on your lip situation. It has nothing to do with 'lip line up' but rather contour irregularity to the labial ledge.
Yeah, I was curious about the A-P relationship between the upper and lower lip because in a prior post you said the subject’s lip orientation is indicative of a class 2 skeletal pattern. I identified a similar A-P lip relationship in my own case and also believe my lower jaw is a bit (relatively) recessed, so I was postulating about whether it is also indicative of a class 2 pattern in my case. That’s a different question than the convexity or convexity of the upper lip itself.
I asked about the ideal because I was trying to figure out what the upper-lower A-P relationship ‘should’ be. I.e, what lip orientation would indicate a balanced skeletal pattern. I’m satisfied with the above answer though.
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Yeah, I was curious about the A-P relationship between the upper and lower lip because in a prior post you said the subject’s lip orientation is indicative of a class 2 skeletal pattern. I identified a similar A-P lip relationship in my own case and also believe my lower jaw is a bit (relatively) recessed, so I was postulating about whether it is also indicative of a class 2 pattern in my case. That’s a different question than the convexity or convexity of the upper lip itself.
I asked about the ideal because I was trying to figure out what the upper-lower A-P relationship ‘should’ be. I.e, what lip orientation would indicate a balanced skeletal pattern. I’m satisfied with the above answer though.
Yes, I said his lip orientation was indicative of class 2 skeletal pattern. BUT the key reference was to his actual before photo where it's ALSO quite obvious he had recession to mandible which was consistent with type 2 skeletal pattern. I established consistency with his lip line up and jaw recession.
So, despite his having the implants to mask the jaw recession, the lip line up remained as prior. That is to say, it was a residual tell tale sign to his skeletal pattern which belied the implants didn't hide it completely.
Unless your before photos reveal your lower jaw was as recessive as his (relative to his upper jaw) and ALSO your lower lip was BEHIND your upper lip (but you say your lip posture was OPPOSITE of his), and also IF my statement contended that lip posture ALONE in absence of seeing jaw posture WITH it was key identifier (which I didn't), there's nothing about the context of my statements for you to self identify with here or for me to 'define' ideal lip posture in A-P because you did just because I ID'd a residual tell tale sign of a posture consistent with another person's highly recessive lower jaw subsequent to his before photo showing BOTH.
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Yes, I said his lip orientation was indicative of class 2 skeletal pattern. BUT the key reference was to his actual before photo where it's ALSO quite obvious he had recession to mandible which was consistent with type 2 skeletal pattern. I established consistency with his lip line up and jaw recession.
So, despite his having the implants to mask the jaw recession, the lip line up remained as prior. That is to say, it was a residual tell tale sign to his skeletal pattern which belied the implants didn't hide it completely.
Unless your before photos reveal your lower jaw was as recessive as his (relative to his upper jaw) and ALSO your lower lip was BEHIND your upper lip (but you say your lip posture was OPPOSITE of his), and also IF my statement contended that lip posture ALONE in absence of seeing jaw posture WITH it was key identifier (which I didn't), there's nothing about the context of my statements for you to self identify with here or for me to 'define' ideal lip posture in A-P because you did just because I ID'd a residual tell tale sign of a posture consistent with another person's highly recessive lower jaw subsequent to his before photo showing BOTH.
My thinking was that I may have been moved into a ‘more’ class 2 position by the operation and that the upper-lower lip A-P relationship differential pre and post op is a reflection of that.
I’m not claiming you ever said the A-P relationship in isolation is a “key indicator” of class 2. Only that there may in fact be some correlation. I’m not trying to draw any hard conclusions about the significance of lip orientation. Just trying to learn more and think about it.
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My thinking was that I may have been moved into a ‘more’ class 2 position by the operation and that the upper-lower lip A-P relationship differential pre and post op is a reflection of that.
I’m not claiming you ever said the A-P relationship in isolation is a “key indicator” of class 2. Only that there may in fact be some correlation. I’m not trying to draw any hard conclusions about the significance of lip orientation. Just trying to learn more and think about it.
It isn't a reflection of that because lip posture ALONE isn't the key identifier of class 2. It's just something seen along WITH the jaw recession someone with class 2 skeletal pattern already has. Convexity of the LABIAL LEDGE of the upper lip post significant maxillary advancement isn't a reflection of 'being put in a class 2 relationship' either.