jawsurgeryforums.com
General Category => Aesthetics => Topic started by: Lefortitude on May 26, 2020, 09:54:31 AM
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https://www.arnettgunson.com/before-and-after-gallery-faces
Not sure if this has been posted already, but they added over a dozen B&A results.
Some of the results are incredible. What do you think?
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The results are impressive, though I would like to see some more class 2 male patients. I'm surprised by how female his client base is. Or maybe his best results are with female patients. I don't know
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I think the results look great BUT I also think the presentation is INCOMPLETE because he does NOT tell the viewer what procedures and basic type of displacements the patients got.
Ironic how he has an EDUCATIONAL section (which seems to be for doctors). But he fails to educate the viewer audience as to the procedures and basic displacements done on the show cased patients.
I anticipate members will be looking at the photos and asking on here what was done. But not too sure I want to waste much brain energy analyzing what was most likely done just because he elects to withhold that type of information on his presentation.
Maybe I should just give a wise crack 'answer' when someone asks what was done on this or that patient and just say: 'Oh Gunson doesn't want you to know. If he did, he would have told you on the same page as the photos.'
Ya, I think that will be my answer.
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I’m probably in the minority here but I think a lot of the patients had such bad starting points (based on their jaws) that any surgeon would have improved them. The HA paste looks good and offers a nice improvement but I mean it’s in no way better than your run of the mill zygomatic osteotomy. I’ve seen more transformative results from other surgeons who are 1/7th the price.
He does seem to have a knack for making the bite absolutely perfect, though. Very impressive.
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I’m probably in the minority here but I think a lot of the patients had such bad starting points (based on their jaws) that any surgeon would have improved them. The HA paste looks good and offers a nice improvement but I mean it’s in no way better than your run of the mill zygomatic osteotomy. I’ve seen more transformative results from other surgeons who are 1/7th the price.
He does seem to have a knack for making the bite absolutely perfect, though. Very impressive.
Midlines are off on quite a few. Not as bad as alfaro, though.
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Midlines are off on quite a few. Not as bad as alfaro, though.
IMO midline discrepancy is not much of an issue unless it causes a functional problem. Nobody will notice it. Much more important for the teeth to mesh with proper overjet and depth at the incisors
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I’m probably in the minority here but I think a lot of the patients had such bad starting points (based on their jaws) that any surgeon would have improved them. The HA paste looks good and offers a nice improvement but I mean it’s in no way better than your run of the mill zygomatic osteotomy. I’ve seen more transformative results from other surgeons who are 1/7th the price.
He does seem to have a knack for making the bite absolutely perfect, though. Very impressive.
The first male result is extremely impressive. Got exactly what he needed. CW rotation helped but the genioplasty is doing a lot of work. At least that's what it looks like to me
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Third guy (underbite) turned into a five-head - lower third too short now.
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Wow, if I knew this existed five years ago I never would have had implants. Amazing.
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Third guy (underbite) turned into a five-head - lower third too short now.
Worth the tradeoff. Plus he can get a HT
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#4 is incredible.
They're all very good to great.
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What about that last male, looks like a genio result.
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What about that last male, looks like a genio result.
A genio fixed his open bite?
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A genio fixed his open bite?
The comparison was more to illustrate that I find the result lacking. Obviously I have no idea what the patient wanted nor do I have the knowledge to really comment on functional improvements but it doesn't look like his jawline improved much to my eye, again, no idea what he actually asked for, so maybe it really is a great result for his situation. For myself I need a far more dramatic movement so I'm comparing it to a result I would want after paying the Gunson price. His pre-surgery jaw is a lot better than mine, I look more like the second guy. So fingers crossed it ends up being worth it. :-\
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I’m probably in the minority here but I think a lot of the patients had such bad starting points (based on their jaws) that any surgeon would have improved them. The HA paste looks good and offers a nice improvement but I mean it’s in no way better than your run of the mill zygomatic osteotomy. I’ve seen more transformative results from other surgeons who are 1/7th the price.
He does seem to have a knack for making the bite absolutely perfect, though. Very impressive.
Odog, can you tell me more about these surgeons, I was going to book with Gunson after I have my consultation in August, but if his results aren't consistently better than the work of lesser known surgeons maybe I can save some of my money for Yaremchuk cheek implants. Kavan and GJ recommended bimax with ccw and I thought the only surgeons who did large downgrafts were Gunson and Wolford.
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I think the results look great BUT I also think the presentation is INCOMPLETE because he does NOT tell the viewer what procedures and basic type of displacements the patients got.
Ironic how he has an EDUCATIONAL section (which seems to be for doctors). But he fails to educate the viewer audience as to the procedures and basic displacements done on the show cased patients.
I anticipate members will be looking at the photos and asking on here what was done. But not too sure I want to waste much brain energy analyzing what was most likely done just because he elects to withhold that type of information on his presentation.
Maybe I should just give a wise crack 'answer' when someone asks what was done on this or that patient and just say: 'Oh Gunson doesn't want you to know. If he did, he would have told you on the same page as the photos.'
Ya, I think that will be my answer.
I agree id like to see more information on each case. I'm sure someone from the A&G team would be willing to listen to this very valuable feedback, especially since theyre doing PR work.
For what its worth, my favourite result was posted about a year ago on the A G fb page. he included some movements
(https://scontent.fybz2-1.fna.fbcdn.net/v/t1.15752-9/s1080x2048/100047707_668387883718010_8805993634789851136_n.jpg?_nc_cat=101&_nc_sid=b96e70&_nc_oc=AQkdqsYP9FyOxAQPV23HUpuVFlbrT3I1QSWvC3DTjZs9X5KeqePNvSKKrCIMUbrJt2I&_nc_ht=scontent.fybz2-1.fna&_nc_tp=7&oh=a6a95f9d6cfc490524a6206d4f0aa7ea&oe=5EF3CC4B)
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That result is interesting because her chin looks longer despite CCW and SG. I think this is largely due to the improvement in lip posture and the vertical component of her BSSO.
Life-changing result. Looks like having her jaw banded shut for several weeks helped out as well.
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I agree id like to see more information on each case. I'm sure someone from the A&G team would be willing to listen to this very valuable feedback, especially since theyre doing PR work.
For what its worth, my favourite result was posted about a year ago on the A G fb page. he included some movements
He's got some stuff up in different places as to what was done as far as the parts seen on the planning model such as in this case. It's just that IF she also had other stuff with that like hydroxyappatite or even under chin fat removal, all should be listed so we don't have to 'cross engineer GUESS' at all.
There's another one floating around where the guy on the new series with the short chin/lower 3rd got an overall thick downgraft in the CW direction which I've used before to convey an OVERALL dowgraft can also have a shift to a CW direction (as in not all down grafts are CCW posterior ones). I just know where it is now.
Basically, all the info as to what they had done would be best put on his website.
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That result is interesting because her chin looks longer despite CCW and SG. I think this is largely due to the improvement in lip posture and the vertical component of her BSSO.
Life-changing result. Looks like having her jaw banded shut for several weeks helped out as well.
From the planning model, where there is a space between the cut, it looks like a downward diagonal genio where space would be filled in with bone buttress. Does not look like a sliding genio.
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From the planning model, where there is a space between the cut, it looks like a downward diagonal genio where space would be filled in with bone buttress. Does not look like a sliding genio.
Oh, yeah. I just interpreted that separation as showing that a genio occurred. Looks like there was actual downward movement then
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Odog, can you tell me more about these surgeons, I was going to book with Gunson after I have my consultation in August, but if his results aren't consistently better than the work of lesser known surgeons maybe I can save some of my money for Yaremchuk cheek implants. Kavan and GJ recommended bimax with ccw and I thought the only surgeons who did large downgrafts were Gunson and Wolford.
PM’d you.
Sadly I thought the same thing, that if I wanted CCW-r with downgraft it was Wolford or Gunson or nothing. Nobody here told me there are Italian surgeons who do it and who don’t cost the price of a mortgage, and they’re actually more aggressive in their movements. Get plans from
both and you’ll see for yourself. You may have more input into the final plan with these surgeons as well, AFAIK Gunson does what he wants, end of story.
I’m not telling you to not go with Gunson, I’m just saying consult with other surgeons and compare the plans.
Of course, the HA paste is a nice touch but it has its flaws as well.
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Worth the tradeoff. Plus he can get a HT
Gunson's criteria for an aesthetically successful surgery is that the deformity no longer draws the viewer's attention from the patient's "good features". Most people would not notice his underbite. I didn't. But his out of proportion forehead draws immediate attention post-op. He does look younger, but so do small children because of their small jaws. I think he had the wrong movements.
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What gives me pause is when surgeons choose to show certain photo angles and not others for different patients. Electrons are cheap, they should show all the photos. Front, profile, 3/4s before and after — all at rest and smiling. Then we'll know if the jaws are yawed and/or canted as can often happen. Whether the tooth show is normal. Teeth - front, top and bottom arches, 3/4 view. Then we'll know if the arches match and the teeth mesh at the back. Anything less makes it look like they have something to hide.
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He also has a bites page here, https://www.arnettgunson.com/our-results-bites
Looks very bullseye to me.
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Anyone can tell if the fifth one from the top seems to have got bimax (i.e. maxillary impaction) or just lower jaw?
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IMO midline discrepancy is not much of an issue unless it causes a functional problem. Nobody will notice it. Much more important for the teeth to mesh with proper overjet and depth at the incisors
A midline is not just a midline. If you have proper mesh, overjet and class I, then there's only one way where the midline can end up. If the midline is off then it's either off somewhere else as well, or it's just an impossible configuration with how the teeth are positioned.
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A midline is not just a midline. If you have proper mesh, overjet and class I, then there's only one way where the midline can end up. If the midline is off then it's either off somewhere else as well, or it's just an impossible configuration with how the teeth are positioned.
I think this is usually due to unaddressed tooth size discrepancy, which may or may not lead to functional issues. And by functional issues I mean practical issues that the patient themselves identifies.
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I think this is usually due to unaddressed tooth size discrepancy, which may or may not lead to functional issues. And by functional issues I mean practical issues that the patient themselves identifies.
I reacted because of my own situation, meaning that the midline can be a a symptom that it traverse on the bite. But I'm with you, the midline it self is not a purpose, it depends on the entire setup.
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I think this is usually due to unaddressed tooth size discrepancy, which may or may not lead to functional issues. And by functional issues I mean practical issues that the patient themselves identifies.
Tooth size discrepancy sounds quite possible. When you consider all the many things they are trying to balance and optimize, they can't get every single thing exactly perfect.
I think, in general, that once they fix the BIG stuff like give a significant improvement to WHOLE, it's easier to zero in on the small PARTS that could be off.
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If people aren't happy with those bites, they shouldn't have jaw surgery.
1mm margin of error from the best surgeons, and those look well within that if not lower. If you expect perfect you will be sorely disappointed.
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If people aren't happy with those bites, they shouldn't have jaw surgery.
1mm margin of error from the best surgeons, and those look well within that if not lower. If you expect perfect you will be sorely disappointed.
Yes, they look perfect to me. But on the other hand you only see what they chose to put up and it's undetermined what amount of post operative orthodontic work was done. But at least it's a good sign that they can distinguish what to put up.
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Yes, they look perfect to me. But on the other hand you only see what they chose to put up and it's undetermined what amount of post operative orthodontic work was done. But at least it's a good sign that they can distinguish what to put up.
I personally know some A/G patients with bad bites post-op. Every surgeon will have that issue, so at that point what is important is how they handle cases gone wrong. But with regard to this thread, all I'm saying is if those photos don't satisfy you, then you shouldn't have surgery.
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Most of the result are quite awesome, particular from 3/4th and profile views.
That said, they better be when you're paying about 70k out of pocket.
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PM’d you.
Sadly I thought the same thing, that if I wanted CCW-r with downgraft it was Wolford or Gunson or nothing. Nobody here told me there are Italian surgeons who do it and who don’t cost the price of a mortgage, and they’re actually more aggressive in their movements. Get plans from
both and you’ll see for yourself. You may have more input into the final plan with these surgeons as well, AFAIK Gunson does what he wants, end of story.
I’m not telling you to not go with Gunson, I’m just saying consult with other surgeons and compare the plans.
Of course, the HA paste is a nice touch but it has its flaws as well.
Thank you for your pm. I'll definitely seek the input of those two surgeons, the price you mentioned was very appealing and the movement very enterprising. Its sad that the majority of surgeons still refuse to integrate down-grafts into their movements, pushing patients seeking the best results into either financial strain or multiple procedures. Hopefully the CW can provide results, apparently in-office before afters are very impressive.
The more I research the standard BSSO the more I find it lacking. Compared to the attached scan, why aren't these kinda cuts more popular? Are surgeons too set in their ways, like the surgeons who refuse to incorporate rotations into their procedure? Do you think its simply lack of exposure to the technique that keeps it in research papers and out of the surgical room?
This was the authors conclusion to the attached procedure;
'This modified BSSO has the same complications as conventional procedures (nerve damage, condylar resorption). However, it requires less exposure of infra-alveolar nerve length, and limits the risk of bad split due to the lack of cortical bone that is left to brake during the cleavage.'
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I have to say that the results page is really good. Not because of the presentation itself, but more of the choose of patients. Nobody looks really special afterwards, but much better than before. So it shows all the "lookism" guys, that there is no "chope", lol. Also it shows, you have really to outweight things, if it is worth to undergo such a major procedure.
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Thank you for your pm. I'll definitely seek the input of those two surgeons, the price you mentioned was very appealing and the movement very enterprising. Its sad that the majority of surgeons still refuse to integrate down-grafts into their movements, pushing patients seeking the best results into either financial strain or multiple procedures. Hopefully the CW can provide results, apparently in-office before afters are very impressive.
The more I research the standard BSSO the more I find it lacking. Compared to the attached scan, why aren't these kinda cuts more popular? Are surgeons too set in their ways, like the surgeons who refuse to incorporate rotations into their procedure? Do you think its simply lack of exposure to the technique that keeps it in research papers and out of the surgical room?
This was the authors conclusion to the attached procedure;
'This modified BSSO has the same complications as conventional procedures (nerve damage, condylar resorption). However, it requires less exposure of infra-alveolar nerve length, and limits the risk of bad split due to the lack of cortical bone that is left to brake during the cleavage.'
Are those images of the same patient? The shape of the skull looks completely different.
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I personally know some A/G patients with bad bites post-op. Every surgeon will have that issue, so at that point what is important is how they handle cases gone wrong. But with regard to this thread, all I'm saying is if those photos don't satisfy you, then you shouldn't have surgery.
I've been reading a couple of poor reviews about gunson as well and of course a surgery of this sort is supposed to have some sort of failure rate but I am worried as most of his patients with -ve reviews have been reporting similar issues with his bone paste and drastic advancements of both the jaws. I wonder if they all were really complex cases or was age a major factor. I seem to be losing hope, my case isn't severe I have a decent bite as a result of orthodontic compensation my main worry is lip incompetence and with such -ve reviews of a top tier surgeon I can't seem to find a light at the end of the tunnel ☹️
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I've been reading a couple of poor reviews about gunson as well and of course a surgery of this sort is supposed to have some sort of failure rate but I am worried as most of his patients with -ve reviews have been reporting similar issues with his bone paste and drastic advancements of both the jaws. I wonder if they all were really complex cases or was age a major factor. I seem to be losing hope, my case isn't severe I have a decent bite as a result of orthodontic compensation my main worry is lip incompetence and with such -ve reviews of a top tier surgeon I can't seem to find a light at the end of the tunnel ☹️
Very cool way of abbreviating a word.
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PM’d you.
Sadly I thought the same thing, that if I wanted CCW-r with downgraft it was Wolford or Gunson or nothing. Nobody here told me there are Italian surgeons who do it and who don’t cost the price of a mortgage, and they’re actually more aggressive in their movements. Get plans from
both and you’ll see for yourself. You may have more input into the final plan with these surgeons as well, AFAIK Gunson does what he wants, end of story.
I’m not telling you to not go with Gunson, I’m just saying consult with other surgeons and compare the plans.
Of course, the HA paste is a nice touch but it has its flaws as well.
ODog, could you also dm me the info too, would be greatly appreciated :). My plan from a noteworthy US name included a downgraft and some impaction for CCW-r. I was going to consult with a few other names and choose one to eventually go with, given all the prices are quite high yet in a similar range. I am intrigued by the possibility of having a more aggressive plan and would love to find out more on my own case for comparison.
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Are those images of the same patient? The shape of the skull looks completely different.
Ya. It does look different. Either a different cross section of the scan or different person. I think the latter due to the root orientation of the maxillary molars.
It would depend on what the article is trying to CONVEY.
'a' has hardware to the maxilla and a steep OP. 'b' has no hardware to the maxilla and a normal OP.
'a' looks like linear advancement over an inherently steep OP where the bimax surgery will just exaggerate BOTH the overly steep OP and MPA.
'b' looks like it's trying to CONVEY a type of BSSO cut and extended genio that counter rotates mandible and the chin to offset the problem 'a' has with NO genio at all to offset the overly steep MPA left by the linear advancement bimax.
Although we are told (in the post) that the reference is to a type of BSSO cut, what is salient in the after photo is a type of extended genio that is giving good CCW rotation.
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Ya. It does look different. Either a different cross section of the scan or different person. I think the latter due to the root orientation of the maxillary molars.
It would depend on what the article is trying to CONVEY.
'a' has hardware to the maxilla and a steep OP. 'b' has no hardware to the maxilla and a normal OP.
'a' looks like linear advancement over an inherently steep OP where the bimax surgery will just exaggerate BOTH the overly steep OP and MPA.
'b' looks like it's trying to CONVEY a type of BSSO cut and extended genio that counter rotates mandible and the chin to offset the problem 'a' has with NO genio at all to offset the overly steep MPA left by the linear advancement bimax.
Although we are told (in the post) that the reference is to a type of BSSO cut, what is salient in the after photo is a type of extended genio that is giving good CCW rotation.
There’s also nothing that proves whether ‘b’ didn’t already have a pretty leveled jaw before.
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There’s also nothing that proves whether ‘b’ didn’t already have a pretty leveled jaw before.
My assumption/guess is that the article is trying to demonstrate a CCW effect on someone with a high MPA. An assumption made in the ABSENCE of 'proof' or knowing what the article is about.
It's given that there is no proof about what the article is about. Are you trying to tell me it's 'wrong' for me to make an assumption of what it could be about.
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My assumption/guess is that the article is trying to demonstrate a CCW effect on someone with a high MPA. An assumption made in the ABSENCE of 'proof' or knowing what the article is about.
It's given that there is no proof about what the article is about. Are you trying to tell me it's 'wrong' for me to make an assumption of what it could be about.
No I’m actually agreeing with you. I’m just stating it’s hard to tell exactly how much was achieved in b if we don’t know the starting point. How do we know that the patient even had a high angle to begin with? Again this is assuming a and b are different people.
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No I’m actually agreeing with you. I’m just stating it’s hard to tell exactly how much was achieved in b if we don’t know the starting point. How do we know that the patient even had a high angle to begin with? Again this is assuming a and b are different people.
Basically, I don't need to see 'a''s before to know that 'a' did NOT get CCW-r. All I need to see is that 'a' has NO APPEARANCE of having had CCW-r. Similarly, I don't need to see 'b's before either to see that 'b' DOES have appearance of CCW-r and of course, from the surgery. Hence, I don't need to 'know' because I can go through a process to assume it.
It's not too different a process of addressing one of your questions about what the woman in Mohaved surgery had. Like nobody told me what she had (doctor didn't list it). But I can go through of process to figure stuff out in the absence of some information as to make a good guess.
Here, I'm just trying to think in terms of what they, the writers, could be wanting to convey when they show those photos side by side (assuming the photos are of different people and from the same article). We have a clue that they want to convey something having to do with CCW rotation. We see that 'a' has NO appearance of a CCW-r (because the OP and MPA are steep). But 'b' has the appearance of CCW-r.
So, it is likely they are wanting to convey something DONE to 'b' to give appearance of CCW-r.
'b' has NO plates to the maxilla, so I'm assuming no CCW-r at the maxilla. That leaves only 2 things to give a CCW-r to the mandible a type of BSSO cut and also a type of extended genio that can give a CCW-r to the anterior mandible and the chin.
Therein comes the assumption that 'b' probably started with a high MPA even though before having the surgery.
Do you have another assumption as to what the authors could be wanting to convey by having those photos side by side?
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I’m probably in the minority here but I think a lot of the patients had such bad starting points (based on their jaws) that any surgeon would have improved them. The HA paste looks good and offers a nice improvement but I mean it’s in no way better than your run of the mill zygomatic osteotomy. I’ve seen more transformative results from other surgeons who are 1/7th the price.
He does seem to have a knack for making the bite absolutely perfect, though. Very impressive.
Which surgeons please ?
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I think the first guy is totally impressive...
What made his face longer ?
It seems his teeth... the size of them is longer , like he got veneers or crowns... something that put more length into them , maybe that contributes to the longer face after ( in a positive way)
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That result is interesting because her chin looks longer despite CCW and SG. I think this is largely due to the improvement in lip posture and the vertical component of her BSSO.
Life-changing result. Looks like having her jaw banded shut for several weeks helped out as well.
Defenetly life changing result.and defenetly her chin got longer. I wonder what the exact procedure making that happen .
Thats the effect i need in my jaw my whole lower third 'shrunk'
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I think the first guy is totally impressive...
What made his face longer ?
It seems his teeth... the size of them is longer , like he got veneers or crowns... something that put more length into them , maybe that contributes to the longer face after ( in a positive way)
Clockwise rotation and genioplasty + good ortho work
Defenetly life changing result.and defenetly her chin got longer. I wonder what the exact procedure making that happen .
See image on pg. 2. CCW rotation + 'out and down' genioplasty