jawsurgeryforums.com
General Category => Aesthetics => Topic started by: fullofsoubts on October 09, 2019, 10:05:33 AM
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Hello!
First of all, english is not my first language so I'll try my best to explain myself :D
I'm a female, 39 years old. I've been thinking about having orthognathic surgery for more than 10 years. This was me before having any procedure done:
Hated my profile, my weak chin and my long lip. But I loved my teeth show. So last year I decided to have a sliding genioplasty and a lip lift. And this is me right now:
My profile looks much better now but still have a weak chin. My proportions are better after the lip lift but now I show too much teeth (although I'm starting to like it). These are the pictures that I had taken in Alfaro consult 1 month ago:
And last week I had my gums fixed (he asked for it because he prefered that I had it done before invisalign and surgery) and now I don't have a super gummy smile like before:
I still have to start the invisalign process next month. The thing is I'm having serious doubts about doing this. I'm 39 years old and I've always looked younger. My biggest fear is to look older and to show little teeth after impaction. Also the changes in my nose and to show too lower teeth. I've seen pictures of his surgeries and they generally end up with little show of teeth. I know showing too much teeth may not be the ideal but I love it. And I prefer too much teeth over over impaction a million times) So after more than 10 years wanting to do this, I'm having serious doubts right now. I consider myself attractive and I'm afraid to lose that, also to look less cute. I'm going crazy thinking about this and I need some honest opinion. Because there are also some things about my face that I hate, like my profile.
He agreed my genioplasty doesn't look good because now my chin sticks out to much of my face. He didn't tell me much but he is going to fix it, also impaction and bsso.
After fixing my gums (gingivectomy ?) my orthodontist think that maybe is not a good idea to have maxillary impaction and that she can impact my teeth like 2 or 3 millimeters with invisalign. But I'm not sure if he will perform only bsso on me, because I'm sure to his standards I still show too much teeth/gums.
Does anybody knows if he performs alar stitch to avoid the changes in the nose ? Almost in all the before afters of his patients I see a lot of changes in the nose. And that is one of the biggest reasons that I'm having so much doubts, because I love mine. By the way, I need to fix my septum and he offered to do that in the same surgery.
Sorry for the super long post and the spam of pictures and I hope it makes sense :)
Thank you in advance!!
Edit: I edited the title of the post, hope you don't mind :)
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Did the lip lift make it harder for you to close your lips? If you have no functional issues, do nothing. It's very hard to prevent the nose from changing. The alar cinch can lengthen the upper lip - the flesh has to go somewhere when the nostrils are "pinched".
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BTW, that lip lift looks amazing. No scarring at all and you have really youthful tooth show.
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Did the lip lift make it harder for you to close your lips? If you have no functional issues, do nothing. It's very hard to prevent the nose from changing. The alar cinch can lengthen the upper lip - the flesh has to go somewhere when the nostrils are "pinched".
Side question, but do alar base reductions (not cinches) also lengthen the lip? I haven't seen that side effect for a reduction.
As for OP, if you like your nose and don't mind a bit of a gummy smile, don't do JS IMO. Maybe a custom implant could augment your lower jaw if that's something you really want.
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Hello PloskoPlus!
Thank you for your answer :)
Yes, now I have lip incompetence and can not close my lips properly. Also have a class 2 and my bite is no good.
I mean, if I had to live with this face for the rest of my life (class 2, lip incompetence, weak jaw, gummy smile, and a bad genioplasty) would not be the end of the world. (I‘ve been through a lot in my life to know what is really important) Although I’ve always been really self concious about it and never let anyone take a pic of me. But on the other side I would love to fix it and have a normal life. I’ve always wanted this so so hard, but the closer I am to do it the scarier it gets.
My fear is to look uglier after the surgery. I tried to Photoshop my face to see a possible outcome but I’m not sure if it’s close to reality. I know my profile will improve 100%, my fear is how will I look from the front.
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BTW, that lip lift looks amazing. No scarring at all and you have really youthful tooth show.
Thank you! But It does not look too good if you look closer. I’ve always had one nostril bigger than the other But after the lip lift my small nostril is much much smaller and the big one now is too big. It’s been 1 and a half years and I’m still healing and have not regain all sensibility.
The first year was terrible because I couldnt speak or esta properly. I still can not speak 100% as I did before.
I asked Alfaro if he would fix it during septoplasty and he said no. He said first septoplasty and then We will see. Anyway I don’t like his rhynoplasties.
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Side question, but do alar base reductions (not cinches) also lengthen the lip? I haven't seen that side effect for a reduction.
As for OP, if you like your nose and don't mind a bit of a gummy smile, don't do JS IMO. Maybe a custom implant could augment your lower jaw if that's something you really want.
Hello Post Bimax! :)
Thank you for your opinion.
Implants are a big NO for me. I dont want anything plastic or whatever in my face (autoimmune issues). And I’m not sure that would fix my bite.
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With so many photos, you really should post them all on the SAME link and add TEXT below them to describe what each one is. Otherwise people have to keep open a zillion tabs just to look and give you advice.
I flipped through a few of them but did not study each one of them which I never do when someone puts up a zillion different links instead of putting all the photos--with descriptions--on ONE link.
Looks like you still have too much tooth show, a gummy smile, long teeth, recessive jaw and chin that could be fixed. There will always be some nose changes or how it looks to you when other things are changed even if the nose changes are minor. The surgery he proposes will probably make you look a lot better even if it changes the nose somewhat which you can later get rhino for.
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Thank you! But It does not look too good if you look closer. I’ve always had one nostril bigger than the other But after the lip lift my small nostril is much much smaller and the big one now is too big. It’s been 1 and a half years and I’m still healing and have not regain all sensibility.
The first year was terrible because I couldnt speak or esta properly. I still can not speak 100% as I did before.
I asked Alfaro if he would fix it during septoplasty and he said no. He said first septoplasty and then We will see. Anyway I don’t like his rhynoplasties.
Wow! Increased tooth show was the main reason I had a lefort 1 advancement. It improved some, but my lip got longer as well. My surgeon suggested a lip lift even as I have permanent numbness in the upper lip (a real scandal). I don't think I can take anymore numbness there.
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Hi Kavan!
Thank you for your answer :)
(Sorry I think they are not in order and don't know how to change it :( )
I agree with you. I know my profile will look ten million times better (it is impossible to look worse), not so sure about the front and the nose. I guess I'm scared that what makes me cute are my imperfections and when I fix them I will lose my appeal. I guess changes will be a wider shorter face ??
I have to fix my nose anyway because I need a septoplasty. If surgery was not changing my nose, I would have the septoplasty done at the same time. But I guess I will have to wait after surgery to have a rhinoseptoplasty and fix whatever changes jaw surgery will cause.
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Wow! Increased tooth show was the main reason I had a lefort 1 advancement. It improved some, but my lip got longer as well. My surgeon suggested a lip lift even as I have permanent numbness in the upper lip (a real scandal). I don't think I can take anymore numbness there.
I'm so sorry that happened to you PloskoPlus. How long ago was the surgery ?
I've had 2 genioplasties, last one more than a year ago and I still haven't regain all my sensibility but each day it gets better, but it is soooo slow.
The thing with the lip lift is that now I have hyper sensibility in my columella. I don't know if it will stay like that forever or it will get better because with my lower lip it was the same after genioplasty and now I don't have that hypersensibility anymore.
I didn't know lip would get longer with a lefort, that's scary.
I would have the lip lift again, I think it has improved my proportions a lot but I would choose another surgeon because this one was a nightmare and I've been crying for so long. I hope I find a surgeon that can fix my scar. Luckily he did the scar inside the nostrils, that way its more difficult to see, because it is really bad done.
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Hi Kavan!
Thank you for your answer :)
You are right, I made an album:
https://imgur.com/a/ldmuLiP
(Sorry I think they are not in order and don't know how to change it :( )
I agree with you. I know my profile will look ten million times better (it is impossible to look worse), not so sure about the front and the nose. I guess I'm scared that what makes me cute are my imperfections and when I fix them I will lose my appeal. I guess changes will be a wider shorter face ??
I have to fix my nose anyway because I need a septoplasty. If surgery was not changing my nose, I would have the septoplasty done at the same time. But I guess I will have to wait after surgery to have a rhinoseptoplasty and fix whatever changes jaw surgery will cause.
The genio you got did not do much for you. But it probably can be revised during bimax and/OR the BSSO advancement alone would help a lot. Alfaro sometimes elects to get the chin point out more just with the BSSO.
The after gum fixing still has it that there is excess gum show. I doubt the gum surgery addressed the slack area UNDER the chin and the problem with the genio you got prior which are visible in the Alfaro shots.
So, ya, you could say that the residual excess gum show you got after gum fixing is 'cute'. But you'd also have to deem the slack under the chin and the overly acute (no pun intended) lip/chin FOLD angle from the genio you got also 'cute'. IMO, those 2 other things don't add to any cuteness.
It's possible your nose tip could rotated down a tad from the impaction. But IF so, it might not be such a bad thing because something like that would tend towards VISUALLY making the upper lip (labial ledge) look shorter and help make to overly open nose holes less visible. In fact some rhino guys sometimes de-rotate the nose tip (rotate it down a tad) to help offset that sort of thing.
What type of lip lift did you get? I ask because I don't see any SILLS below your nose holes. Sills are little ledges right below the nose holes. There is a type of LL, sometimes called the 'Italian' LL or 'no scar' LL which ends up removing the sills because they cut through them to put the scars inside the nostrils whereas the 'bullhorn' LL goes right under base of nose, does not destroy sills and leaves an imperceptible scar.
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Yes, he told me he would revise the genioplasty because he didn't like how it looks right now because it sticks out too much and I agree. So I hope he fixes it.
When I say that I like a little gum and teeth show I don't mean that I'm happy with what I got now. I think I show too much gum and too much teeth. But I mean I'm scared the impaction will let me with little to no teeth show and with an older person smile. I would just cut off 3 mm of my gum but I don't know if that is possible. And also 3 mm of teeth show. That would be perfect. I'm unhappy with my gummy smile but I think I would be unhappier with an older woman smile.
I also agree with what you say about the deep chin fold, I hate it and I hope it can be fixed with the bsso. He also told me it would be like a little lifting to my neck.
Before I did the genioplasty, I used to have a smooth transition between my jaw and chin. Now it looks like I have jowls. I was a lot worse before because it was really swollen and now looks better but I still have that and I think it is because now my chin sticks out too much and looks separated from my face. I hope the jaw surgery can fix this also :(
Also I'm scared about my lower lip because it is like really separated from the teeth, like it hangs out when I open my mouth. When I got the surgery what will happen ? It will stay like that ?
If my nose tip rotated down I would have it fixed because that is something I'm certainly not looking forward to.
You are sooooooo right about my lip lift!!!! oh my god, during all this time I thought he performed a bullhorn lip lift but on the inside of the nose, but he did exactly what you say!! an italian lip lift!! He removed my sills (I didn't know there was a word for it) and I hate it.
Do you think a plastic surgeon can reconstruct that part of my nose ? I've cried a lot because of this, and I hope one day I can fix it.
Thank you so much for taking your time answering me :)
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I think it will be worth it for you. Alfaro is a great choice for you because hes one of the few worldwide who really puts a big emphasis on aesthetics in his clinical practice. Theres no way to know for sure how you will look after, but most often it's favorable!
best of luck, keep us posted on your experience if you decide to proceed.
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Yes, he told me he would revise the genioplasty because he didn't like how it looks right now because it sticks out too much and I agree. So I hope he fixes it.
When I say that I like a little gum and teeth show I don't mean that I'm happy with what I got now. I think I show too much gum and too much teeth. But I mean I'm scared the impaction will let me with little to no teeth show and with an older person smile. I would just cut off 3 mm of my gum but I don't know if that is possible. And also 3 mm of teeth show. That would be perfect. I'm unhappy with my gummy smile but I think I would be unhappier with an older woman smile.
I also agree with what you say about the deep chin fold, I hate it and I hope it can be fixed with the bsso. He also told me it would be like a little lifting to my neck.
Before I did the genioplasty, I used to have a smooth transition between my jaw and chin. Now it looks like I have jowls. I was a lot worse before because it was really swollen and now looks better but I still have that and I think it is because now my chin sticks out too much and looks separated from my face. I hope the jaw surgery can fix this also :(
Also I'm scared about my lower lip because it is like really separated from the teeth, like it hangs out when I open my mouth. When I got the surgery what will happen ? It will stay like that ?
If my nose tip rotated down I would have it fixed because that is something I'm certainly not looking forward to.
You are sooooooo right about my lip lift!!!! oh my god, during all this time I thought he performed a bullhorn lip lift but on the inside of the nose, but he did exactly what you say!! an italian lip lift!! He removed my sills (I didn't know there was a word for it) and I hate it.
Do you think a plastic surgeon can reconstruct that part of my nose ? I've cried a lot because of this, and I hope one day I can fix it.
Thank you so much for taking your time answering me :)
Although I can't predict your outcome, as to your fears of having NO tooth show, he would factor tooth show at rest and smiling, how much, into the surgery. You still have gummy smile and long teeth.
Lower lip hang gets addressed/alleviated when the bone is advanced forward which gives more support, from BSSO and chin.
Even if the nose doesn't change much, the new relationship that the jaws have to the face (which should be an improvement) can make the nose look different. For example, same nose on parts of the face that changed can look different.
If you'd be seeking out a nose guy after surgery, it's possible to compensate if issue is loss of nose support. Rebuilding sills, I'm not so sure. Maybe possible to have micro injections of either fat, filler or silicone to construct a small ledge like the sill was.
ETA: Bullhorn is always performed SUBNASA. Not inside the nostrils. So, ya, you got that 'Italian LL' where the LURE is to tell patients it's 'no scar' LL.
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I think it will be worth it for you. Alfaro is a great choice for you because hes one of the few worldwide who really puts a big emphasis on aesthetics in his clinical practice. Theres no way to know for sure how you will look after, but most often it's favorable!
best of luck, keep us posted on your experience if you decide to proceed.
Hello Lefortitude :)
My main motivation is aesthetics so I hope you are right!
I'm waiting for the invisalign to arrive to my orthodontist office so I can start. I had to do the 3D scan twice because when I got the gingivectomy the position of my gums changed and had to do it again.
I think my case may be similar to this one on their page: https://www.institutomaxilofacial.com/es/caso-clinico/silvia-2/
She looks much better after. But she also got a rhinoplasty and has a ton of makeup on lol
Thank you four your words, I will keep you posted :)
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Although I can't predict your outcome, as to your fears of having NO tooth show, he would factor tooth show at rest and smiling, how much, into the surgery. You still have gummy smile and long teeth.
Lower lip hang gets addressed/alleviated when the bone is advanced forward which gives more support, from BSSO and chin.
Even if the nose doesn't change much, the new relationship that the jaws have to the face (which should be an improvement) can make the nose look different. For example, same nose on parts of the face that changed can look different.
If you'd be seeking out a nose guy after surgery, it's possible to compensate if issue is loss of nose support. Rebuilding sills, I'm not so sure. Maybe possible to have micro injections of either fat, filler or silicone to construct a small ledge like the sill was.
ETA: Bullhorn is always performed SUBNASA. Not inside the nostrils. So, ya, you got that 'Italian LL' where the LURE is to tell patients it's 'no scar' LL.
The scar I got is so ugly and bad done that I'm happy he did it on the inside. But of course I would prefer to get a well done bullhorn lip lift.
If anybody is reading this and is thinking about getting a lip lift, please look for a surgeon who specializes in lip lifts and do tons of them, there are a few of them out there and I still think is a fantastic procedure when is well done. I would do it again a million times, but of course with another surgeon.
That's great to know about the lower lip! Regarding the nose.. we will see but I guess I'll start saving for a rhinoplasty just in case lol
Again, thank you for your help :)
If anyone has any question regarding Alfaro or my experience I will be happy to share my experience if that can help anybody :)
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Hello Lefortitude :)
My main motivation is aesthetics so I hope you are right!
I'm waiting for the invisalign to arrive to my orthodontist office so I can start. I had to do the 3D scan twice because when I got the gingivectomy the position of my gums changed and had to do it again.
I think my case may be similar to this one on their page: https://www.institutomaxilofacial.com/es/caso-clinico/silvia-2/
She looks much better after. But she also got a rhinoplasty and has a ton of makeup on lol
Thank you four your words, I will keep you posted :)
why is her mandible angle still so steep in the after? It looks like it's hardly changed. I thought Alfaro does aggressive CCW rotation? Shouldn't that make the mandible angles more perpendicular and the mandible rest on a flat plane?
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also, out of curiosity, does Alfaro do posterior downgraft for CCW like Gunson? Thanks.
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also, out of curiosity, does Alfaro do posterior downgraft for CCW like Gunson? Thanks.
I'm not sure if "like" refers to something specific like the extremes but Alfaro's plan for me did have 4mm PNS downward, ANS unchanged, CCW with a posterior downgraft.
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why is her mandible angle still so steep in the after? It looks like it's hardly changed. I thought Alfaro does aggressive CCW rotation? Shouldn't that make the mandible angles more perpendicular and the mandible rest on a flat plane?
Sorry Lazlo. But the way you ask your question sounds kind of retarded.
1: Perpendicularity or perpendicular to refers to the relationship between 2 LINES (or planes) that intersect at a 90 degree angle. The angle itself is called either a 90 degree angle or a right angle. Angles themselves don't become 'more perpendicular' by rotating them. They remain the same angles.
2: If you're referring to a 90 degree angle, not all 90 degree angles 'rest on a flat plane' because not all 90 degree angles are formed by one line being parallel to a vertical plane intersecting with another that is parallel to the horizontal plane. 90 degree angles can also be formed by one line being (for example) 'X' degrees CW away from the vertical plane and the the other line being 'X' degrees CW away from the horizontal plane, in which case they won't be resting on a flat plane but angled (or rotated CW) 'X' degrees away from a flat plane. Only 90 degree angles formed by the intersection of one line being parallel to the vertical plane and the other line being parallel to the horizontal plane will 'rest on a flat plane'
3: The 'mandible angle'--the angle of the mandible or gonial angle-- is the angle formed by the posterior border of the ramus and the inferior border of body of the mandible.
It's NOT the same thing as the mandibular PLANE angle, the part of the lower jaw that can look STEEP. The MPA is (basically) the angle of inclination the inferior border of the mandibular body has away from a horizontal plane. The MPA is DIFFERENT angle from the angle of the mandible (gonial angle or 'mandible angle').
A ROTATION does NOT change the angle of the mandible. Angle of mandible stays the SAME. What changes, via rotation (coming from the maxilla), is the angle of INCLINATION the inferior border of the body of the mandible has with a horizontal plane. Angle of mandible and Mandibular Plane Angle (MPA) are 2 different angles.
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The question: 'Why is her mandible [PLANE] angle still steep' resolves to ASSUMING that 'just because he does aggressive CCW', he did so on that patient.
The description does NOT say WHAT KIND of rotation she had. But it does give a CLUE that it was most likely NOT 'aggressive CCW'. The clue is that it says she had OPEN BITE (most likely anterior open bite) which is often treated by removing a wedge section from the posterior maxilla which is CW. There is NOTHING in the description of what she had that gives rise to assuming she had CCW, yet alone 'aggressive CCW'.
So, here's some questions for YOU:
Are you assuming that just because a doctor can do aggressive CCW rotation, that can be done in ALL patients?
If 'Yes', then FAULTY ASSUMPTION
Why are you assuming that just because he does aggressive CCW rotation, he DID so in THAT patient?
Why AREN'T you assuming that because her MPA is still steep (or as steep as prior) he DIDN'T do 'aggressive CCW' on her?
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Looks like she also had anterior impaction of some sort cause the amount of incisor display at rest and on smile changed.
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Sorry Lazlo. But the way you ask your question sounds kind of retarded.
1: Perpendicularity or perpendicular to refers to the relationship between 2 LINES (or planes) that intersect at a 90 degree angle. The angle itself is called either a 90 degree angle or a right angle. Angles themselves don't become 'more perpendicular' by rotating them. They remain the same angles.
2: If you're referring to a 90 degree angle, not all 90 degree angles 'rest on a flat plane' because not all 90 degree angles are formed by one line being parallel to a vertical plane intersecting with another that is parallel to the horizontal plane. 90 degree angles can also be formed by one line being (for example) 'X' degrees CW away from the vertical plane and the the other line being 'X' degrees CW away from the horizontal plane, in which case they won't be resting on a flat plane but angled (or rotated CW) 'X' degrees away from a flat plane. Only 90 degree angles formed by the intersection of one line being parallel to the vertical plane and the other line being parallel to the horizontal plane will 'rest on a flat plane'
3: The 'mandible angle'--the angle of the mandible or gonial angle-- is the angle formed by the posterior border of the ramus and the inferior border of body of the mandible.
It's NOT the same thing as the mandibular PLANE angle, the part of the lower jaw that can look STEEP. The MPA is (basically) the angle of inclination the inferior border of the mandibular body has away from a horizontal plane. The MPA is DIFFERENT angle from the angle of the mandible (gonial angle or 'mandible angle').
A ROTATION does NOT change the angle of the mandible. Angle of mandible stays the SAME. What changes, via rotation (coming from the maxilla), is the angle of INCLINATION the inferior border of the body of the mandible has with a horizontal plane. Angle of mandible and Mandibular Plane Angle (MPA) are 2 different angles.
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The question: 'Why is her mandible [PLANE] angle still steep' resolves to ASSUMING that 'just because he does aggressive CCW', he did so on that patient.
The description does NOT say WHAT KIND of rotation she had. But it does give a CLUE that it was most likely NOT 'aggressive CCW'. The clue is that it says she had OPEN BITE (most likely anterior open bite) which is often treated by removing a wedge section from the posterior maxilla which is CW. There is NOTHING in the description of what she had that gives rise to assuming she had CCW, yet alone 'aggressive CCW'.
So, here's some questions for YOU:
Are you assuming that just because a doctor can do aggressive CCW rotation, that can be done in ALL patients?
If 'Yes', then FAULTY ASSUMPTION
Why are you assuming that just because he does aggressive CCW rotation, he DID so in THAT patient?
Why AREN'T you assuming that because her MPA is still steep (or as steep as prior) he DIDN'T do 'aggressive CCW' on her?
cool thanks for clarifying. do you know at all if alfaro does aggressive ccw and posterior downgraft? I just don't know if he has that in his skillset. i've heard he does (don't remember the source) just want it confirmed. thanks!
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cool thanks for clarifying. do you know at all if alfaro does aggressive ccw and posterior downgraft? I just don't know if he has that in his skillset. i've heard he does (don't remember the source) just want it confirmed. thanks!
Confirmed
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cool thanks for clarifying. do you know at all if alfaro does aggressive ccw and posterior downgraft? I just don't know if he has that in his skillset. i've heard he does (don't remember the source) just want it confirmed. thanks!
If you mean does he do a CCW posterior downgraft close to 10mm 'like' Gunson can do, (if called for), to the best of my knowledge, yes.
ETA: Ya, it does look like she had some CCW (some anterior impaction) but not the type which is significant (aggressive) CCW posterior downgraft.
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Hello again!
This week I finally started with my invisalign and now my orthodontist wants to impact my upper teeth with the invisalign. She thinks that maybe this way the maxillary impaction will not be necessary. And if, after the orthodontic treatment still have some gummy smile, then to do the double jaw surgery and impact the maxilla. But I'm not sure about that :-\
She says we will see it as we go along.
What would be the aesthetic differences in impacting the maxilla with surgery and intruding the upper teeth with invisalign ? All I know is that in the beginning Alfaro wanted to do double surgery on me, maxillary impaction and bring jaw forward, plus genioplasty correction. I don't know if he wanted to rotate it or something. Will he be able to do it this way ?
If I impact the teeth with invisalign and then decide I need more impaction will it be enough room to move the jaws ?
Also I have lip incompetence, if she impacts my teeth with invisalign, will this be corrected ? Or that can only be solved with maxillary impaction ?
I also don't like that if my upper teeth is intruded with the invisalign then my lower teeth will be more exposed.
I'm thinking about writing an email to Alfaro office with my doubts but my orthodontist thinks It`s not necessary.
What do you think ?
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Your photos are now gone to hard to opine.
In GENERAL, it depends on whether or not you have either too much TOOTH show or GUM show. If your teeth are really long (too much tooth show), then orthodontic impaction will make tooth show less IF 'long' teeth are problem. However if long frontal maxilla is problem, that shows itself as too much GUM SHOW. Intruding teeth will not make the gum show less.
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Hello Kavan :)
If I’m not mistaken she told me she will impact the upper teeth with invisalign from the bone.
She sent me the clincheck video and that is what it looks like. Also I just had a gingivectomy a couple of months ago.. So intruding just the teeth would make not sense? :-\
I have both problems: long teeth and long maxilla. I will post the pictures again and I’ll try to post the clincheck video too.
One of my main concerns is that if I do the impaction only with invisalign, will the surgeon be able to move the jaw forward as much as with double jaw surgery ?
Thank you! :)
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When you say 'impact' the teeth, I think you mean INTRUSION. To the best of my knowledge, I don't think intrusion shortens the bone or makes less gum show. It just makes LESS tooth show.
I'm just telling you to self evaluate...you know...you can see if you have excess gum show or excess tooth show. Excess gum show is addressed by surgical impaction. THat also takes care of the excess tooth show.
If you are having surgery, your ortho has to work WITH the surgeon as in acheive what he's asking him/her to acheive in preparation for surgery.
If you do something that is NOT in the surgeon's PLANS for the surgery, it CHANGES the plan. So, IF his plan is to IMPACT the maxilla to make less BOTH tooth and gum show and he's counting on the extent of that impaction for the CCW rotation he wants for lower jaw to swing up more--or whatever else-- you could be altering his plans if you are working INDEPENDENTLY with the ortho as opposed to the surgeon giving the directives to him/her as to what he wants the ortho to achieve.
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These bloody orthos. Always going rogue.
Does Alfaro give your ortho some sort of direction/instructions? If not, maybe ask that he does.
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Hello again!
I wrote to A. office and spoke with their treatment coordinator. She says I should not worry and that if when the time comes, It's only necessary to do the lower jaw, that would be no problem. It happens sometimes.
She also told me that it should not affect the room for manoeuvre that the doctor will have. And that in six months I should visit with him and according to my progress he will evaluate what we should do.
She also says that my orthodontist probably already spoke to A. regarding this (I know they've spoke several times before regarding my case). I will ask my ortho this in two weeks in my next invisalign appointment.
So let's say the ortho fixes my gummy smile and the dr. needs to do rotation in order to fix my jaw. Will that be possible if I don't have a gummy smile anymore? I think that would be my main concern given that I don't have that much space in my lower jaw to move it forward and I think I would need a big movement to fix it.
Here are some pictures from the clincheck:
https://imgur.com/a/2tmPcDT
My ortho says these are very exaggerated movements and It would not be like that in reality.
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Hello again!
I wrote to A. office and spoke with their treatment coordinator. She says I should not worry and that if when the time comes, It's only necessary to do the lower jaw, that would be no problem. It happens sometimes.
She also told me that it should not affect the room for manoeuvre that the doctor will have. And that in six months I should visit with him and according to my progress he will evaluate what we should do.
She also says that my orthodontist probably already spoke to A. regarding this (I know they've spoke several times before regarding my case). I will ask my ortho this in two weeks in my next invisalign appointment.
So let's say the ortho fixes my gummy smile and the dr. needs to do rotation in order to fix my jaw. Will that be possible if I don't have a gummy smile anymore? I think that would be my main concern given that I don't have that much space in my lower jaw to move it forward and I think I would need a big movement to fix it.
Here are some pictures from the clincheck:
https://imgur.com/a/2tmPcDT
My ortho says these are very exaggerated movements and It would not be like that in reality.
Hi,
I don't have a CRYSTAL BALL and can't answer what your surgeon will do IF you do 'this or that--whatever--' with ortho.
All I can tell you is that your ortho and surgeon need to have DIRECT COMMUNICATION and the surgeon needs to DIRECT the ortho with reference to what ever his plans are for the surgery.
If you need predictions as to what your surgeon will do with reference to different hypothetical ortho outcome possibilities, then you will need to ask the SURGEON'S OFFICE.
It looks like you ALREADY HAVE and GOT an answer from them. YET, you are STILL asking here.
I'm neither Alfaro's surgical assistant nor secretary. Your doubts and uncertainties about your upcoming surgery exceed my capacity to resolve all of them for you.
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Hey! I just got surgery this morning!
Not sure but I think I got BSSO, maxillary impaction, CCW rotation, genioplasty and septoplasty.
I’m pretty swollen right now but I think It’s going to look great
I will post pictures when I’m home
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https://ibb.co/VQkg7nG
A before and after I took before the swelling kicked in
Maybe I wont need a nosejob after all ;D
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looks rly great!!
what were the movements (impaction/advancement/etc) if u know?
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Nice.
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looks rly great!!
what were the movements (impaction/advancement/etc) if u know?
Hello deoplyfe! I dont know the exact movements in milimeters but what I got is what I mentioned in my other post.
I’m feeling better than yesterday, but I know It’s going to be a long road to recovery
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Hey! I just got surgery this morning!
Not sure but I think I got BSSO, maxillary impaction, CCW rotation, genioplasty and septoplasty.
I’m pretty swollen right now but I think It’s going to look great
I will post pictures when I’m home
For rotations, are they a result of impaction or downgrafting or are they separate movements. For example if you get an impaction isn’t that always gonna be a CCW since your face gets shorter? Or can you get just a CCW rotation without an impaction?
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For rotations, are they a result of impaction or downgrafting or are they separate movements. For example if you get an impaction isn’t that always gonna be a CCW since your face gets shorter? Or can you get just a CCW rotation without an impaction?
Posterior downgrafts can be combined with anterior impaction.
Anterior and posterior downgrafts can be combined too produce CCW-rotation as well - more posterior, less anterior. For example, if someone has poor tooth show, yet a retrusive steep mandible.
For example, see how the maxilla was (allegedly) lowered at the front and back, but moreso at the back:
https://www.institutomaxilofacial.com/es/caso-clinico/pelle/
(BTW, I'm not endorsing Alfaro. He has a crapload of bad results for every good one).
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Hey guys,
I'm on day 10 post op, and let me tell you.. first week was HELL. Worse than I expected, but I'm a little bit better now.
Swelling has come down a little. The worst part is the swelling under the nose, which looks significantly wider. I'm trying not to worry too much because it is too soon for that, and I remember telling the dr that I didn't want a wider nose and he told me in my case that wouldn't be a problem. I guess he used an alar stitch or something like that. And to calm myself down I see images from when I was fresh out of surgery and the swelling hadn't really kicked in. It was a little bit wider and swollen but nothing to worry too much.
The thing is that today I read that the alar stitch is temporary. Is this true ? Is possible that my nose won't get back to the original shape or the shape it was just two hours after surgery ?
I'd love to hear your opinions and experience!
Thanks in advance
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Hi, can you share your recovery process, how was it like?
hope you recover quickly!
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Thank you random random!
The first 2 or 3 days, the worst was throat pain because of the general anesthesia tube, the rest of my face was pretty much numb. I spent one night at the hospital and was sent home the following day.
At home I started regaining feeling and a lot of pain came with it, so the first week was hell. I still have pain, specially on the afternoons and nights, but now it is manageable with medication. The worst is when I smile.
Also I have 6 screws on my gums because of the invisalign and they are a total pain in the ass.
Swelling has come down a lot, but I'm still very swollen. I look disfigured and I'm at that point where you start questioning if all of this was worth it.
You have to be mentally prepared because it's going to be tough so I'm trying to be patient and remember that it's going to get better eventually.
Hope that helps :)
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https://ibb.co/rZw5VQq
One month and one week post op. Still pretty swollen, specially under my no se, chin and cheeks
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https://ibb.co/rZw5VQq
One month and one week post op. Still pretty swollen, specially under my no se, chin and cheeks
can you show us in comparison to before pics? frontal and profile please.
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Looks great.
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Thank you! I hope my chin doesnt end up looking this pointy, because this was my third genioplasty and would hate to have to do it again. Hopefully a lot of it is just swelling. If not maybe filling the mentolabial fold a bit could help, But It’s too soon to know
Here is a profile comparison. First one is my original face. Second one after second genioplasty and liplift. I dont have pictures of the first genioplasty because I got it fixed a couple of months after and it was a nightmare. Third one is 1 month post DJS, third genioplasty, septoplasty and turbinectomy. And still pretty swollen
https://ibb.co/XJYbkP9
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Looks like an improvement to me.
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this was my third genioplasty
Do you have permanent numbness in the chin from all that?
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Do you have permanent numbness in the chin from all that?
Not at all :)
The only numbness that I have is in the collumela because of the lip lift. Right now my chin still feels a little weird and tingly but surgery was one month ago so It’s normal.
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(BTW, I'm not endorsing Alfaro. He has a crapload of bad results for every good one).
Hi !
I know this post is old but I just read it. I am considering surgery with Alfaro. I'd be very interested if you can tell me where you saw bad results of him ? Thanks a lot !
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Hi !
I know this post is old but I just read it. I am considering surgery with Alfaro. I'd be very interested if you can tell me where you saw bad results of him ? Thanks a lot !
I have had surgery with him last week.
I'm still very swollen so it's hard to see the final result, but from how I look right after the op, and also as far as everything else, so far so good.
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Hello there!
In three weeks will be one year since I got the surgery. Although I must say that 6 months ago I removed all of the hardware so that was another surgery.
I'm still swollen, specially under my nose and chin and around my mouth. I'm patienly waiting for my lips to reappear. Same happened when I got my lip lift 3 years ago, and my upper lip ended up getting back again. But this time I'm worried because my mouth seems so much wider than before. Is this normal ? Has this happened to anybody else ? I'm aware that I'm still swollen around my mouth and some of the volume will come back but I don't know why my mouth seems this much wider.
https://imgur.com/1SjKqX9
Thanks in advance guys!