jawsurgeryforums.com
General Category => Functional Surgery Questions => Topic started by: Raya on February 26, 2023, 11:33:59 AM
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dear members,
Here are some photos of the situation. I would like to hear what you think about the situation.
https://imgur.com/a/d5tAaXq
this is the situation before the v line and rhinoplasty.
https://imgur.com/a/rotDWTJ
This is after. I don't understand how it is possible that my chin is so crooked and the one on the scan is not. I have a feeling that the scan isn't mine. the doctor doesn't want to give me another scan either.
https://imgur.com/a/VRCiN7D
as you can see my lip position is out of balance.
https://imgur.com/a/FlaNK4l
this is Dr Defranq's simulation.
Thank you for thinking along. I've fallen into a deep depression and hate the day I ever got into it.
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When you say your lip position is out of balance, what exactly do you mean?
I do think it's your scan. I can see the step off in the chin, and it's showing in the flesh.
I would think a revision genio could maybe (a) reattach the mentalis higher to show less lower tooth at rest and (b) fix the step off by better centering the chin and/or using graphing material like bone or HA.
This would probably be the least invasive way to deal with the issues, if I'm understanding your issues correctly. I'm not sure I am.
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I am confused. The pictures in this link https://imgur.com/a/rotDWTJ show the before AND after scan with the bottom picture being the after v-line??
If this is the case: In the bottom picture you can clearly see that volume is missing on the left side of the chin (compared to the other side), which in turn causes the slant.
Personally I don't think the lip lineup is the problem. Temporarily you could try to balance out the volume deficiency on the left chin side with filler.
I uploaded a pic for clarification: https://imgur.com/a/okIIoFO
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Sorry to say but your presentation; how you organize information is a poor one and would require excess time just to unravel the haphazard presentation.
I suggest the following as it applies to a better presentation:
1: Make CLEAR which image is the before and after.
2: Don't expect any advice on your NOSE based on a scull scan that does NOT show the nose.
All I can determine here is that you don't like what you see in the MIRROR subsequent to 2 bone cutting surgeries. However no one here can see what you see (and don't like) in the mirror based on bone scans. (Because no full face frontals or profiles are given).
On a side note IMGUR, at least for me, CUTS off visibility to some of the links.
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How to upload pictures in french:
https://fr.wikihow.com/t%C3%A9l%C3%A9charger-des-images-sur-Imgur
As kavan said
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How to upload pictures in french:
https://fr.wikihow.com/t%C3%A9l%C3%A9charger-des-images-sur-Imgur
As kavan said
IMGUR actually doesn't work for me anymore. For some reason, it makes the photos disappear (for me) and/or just shows a grey screen void of photos. Sometimes, it will let me see one photo link. Other photo links not. So, when people elect to put their photos on multiple imgur links instead of all photos on one imgur link, chances get LOWER for my seeing all their photos.
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This is before any surgery
https://imgur.com/a/07elQHS
This is after with genioplasty
https://imgur.com/a/g0ivBg3
This is after v line, rhinoplasty
https://imgur.com/a/N0ZT8xO
I hope it's okay this way. I WoW like to know if a downgraft of the upper jaw and a cw setback will improve.
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I still stand with my original statement, especially if we consider the scan in the previous post. It seems that more bone was shaved on one side and that's why the chin looks crooked. The chin is actually fine, it is the side of the chin that is the problem.
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IMGUR actually doesn't work for me anymore. For some reason, it makes the photos disappear (for me) and/or just shows a grey screen void of photos. Sometimes, it will let me see one photo link. Other photo links not. So, when people elect to put their photos on multiple imgur links instead of all photos on one imgur link, chances get LOWER for my seeing all their photos.
Hmm, maybe you could try a different browser?
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Hmm, maybe you could try a different browser?
TBH, I stick to the browser I'm using and easier to look at photos uploaded on this site.
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I still stand with my original statement, especially if we consider the scan in the previous post. It seems that more bone was shaved on one side and that's why the chin looks crooked. The chin is actually fine, it is the side of the chin that is the problem.
Yes, this is what I said in the first post: I can see the step off in the chin, and it's showing in the flesh.
It's very clear on the side of the chin.
It looks like either the face/chin was elongated or the mentalis wasn't attached correctly because there's excess lower tooth show in the after photos. Though, the prior photo is a smile, which is totally different, making comparisons impossible.
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I am confused. The pictures in this link https://imgur.com/a/rotDWTJ show the before AND after scan with the bottom picture being the after v-line??
If this is the case: In the bottom picture you can clearly see that volume is missing on the left side of the chin (compared to the other side), which in turn causes the slant.
Personally I don't think the lip lineup is the problem. Temporarily you could try to balance out the volume deficiency on the left chin side with filler.
I uploaded a pic for clarification: https://imgur.com/a/okIIoFO
Your observation of soft tissue having somewhat of a dip where there is a dip to the bone is a CORRECT one.
What I can offer so far to this thread is what a 'V line' procedure is and what it really isn't. It looks to to me that the OP may have had somewhat of a V line to begin with and may have requested the chin to be made shorter. Although there are no bone scans of before any surgery, the 'before' presentation where you see the step offs flanking the chin, is consistent with the chin being made shorter (via a horizontal segment cut from the central chin). So, the 'V line' stated here that the OP ostensibly had was most likely a restoration of the chin that was prior shortened (setting it down lower). That's consistent with the step offs flanking the 'before' scan being blended in more with the after. (Refer to the illustrations to see what happens with different types of cuts.)
Since the presentation/communication from the OP is hard to follow, when that is the case, it is not uncommon for miscommunication to transpire during requests for changes.
I will also add that the OP didn't relay anything about a zygomatic osteo which is seen in the after and although I could not 'capture' the before soft tissue photos (presented later), I'm a loss to explain why the skin color was DARK in one of the soft tissue shots (could not 'capture' it on IMGUR) but very LIGHT in the close up of the chin.
Included here is an illustration, with some explanations of what I observed based on the illustrations and photos. That's all that can be offered given the OP's presentation.
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What I can offer so far to this thread is what a 'V line' procedure is and what it really isn't. It looks to to me that the OP may have had somewhat of a V line to begin with and may have requested the chin to be made shorter. Although there are no bone scans of before any surgery, the 'before' presentation where you see the step offs flanking the chin, is consistent with the chin being made shorter (via a horizontal segment cut from the central chin). So, the 'V line' stated here that the OP ostensibly had was most likely a restoration of the chin that was prior shortened (setting it down lower). That's consistent with the step offs flanking the 'before' scan being blended in more with the after. (Refer to the illustrations to see what happens with different types of cuts.)
Ok very useful presentation of how bone cutting and shaving can be used together in these v-line procedures. Thanks! Again, learned something new.
Also I think for OP the blue statement at the end is important!
Raya, check the statement in blue by kavan in the picture.
.... It would not call for another bone cutting surgery.
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thank you for thinking along. sorry for the bad presentation. I'm not very good at it.
it's also chaos in my head because so much has happened. I don't have the last scan yet because the doctor claims that everything went well. She won't explain to me what happened.
I did indeed have a djs with a genioplasty. they had placed the chin back crookedly and hadn't taken the sides of the jaw which made me feel this. as seen in this scan and Photo.
https://imgur.com/a/d5tAaXq
https://imgur.com/a/g0ivBg3
I then went to Dr defranq for a consultation. He wanted a downgraft upper jaw and a cw setback lower jaw to return to my old face as best as possible. I had then visited a doctor in the Netherlands. she could do the same, she said with a v line (that's what she called it). so apparently she has removed too much of the side of the jaw, so that why my chin is crooked.
as you van see in the picture my lower jaw is too far forward, like a male lower jaw. now I am looking for a doctor who can do the downgraft upper jaw and setback lower jaw for me as Dr Defranq said.If you look at my scan you think it is feasible.
Thanks!
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https://imgur.com/a/XesRfaN
The simulation from Dr Defranq
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Ok very useful presentation of how bone cutting and shaving can be used together in these v-line procedures. Thanks! Again, learned something new.
Also I think for OP the blue statement at the end is important!
Raya, check the statement in blue by kavan in the picture.
.... It would not call for another bone cutting surgery.
You are a very good recipient for learning.
As to the (basic) 'V line' surgery, I go by the KOREAN approach in which they use basic geometrical concepts to change the shape of one figure to another which involves planning types of cuts to displace/remove bone. For the most part, they use sharp cutting instruments for the main shape and reserve burring and/or shaving to later 'round out' residual (or unwanted angularity). I mention that because some surgeons call what they do 'V line' but it is NOT the Korean approach.
Korean approach resolves to solving this basic geometric question which is:
Q: 'Given the wide and blunt chin contour in scull 'a', HOW would you get to the contour of scull 'd' using cuts and bone displacement/removal. Also, WHEN would burring/shaving be used?
A: 'Via a horizontal cut through the (wide) chin and 2 vertical cuts below, spaced a distance apart equal to the excess width. Remove middle segment and move the lateral segments inward to close the gap. Then a straight line diagonal cut from the 'step-off' to the back of the jaw angle. Burring would be reserved for rounding out residual angularity to the posterior jaw for a more (overall) 'rounded' V contour IF all angularity to mandible were to be removed.
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Now, as to the after scull scan, the surgeon was tasked with UNDOING an overly shortened chin (and calling it a 'V line). Except for the scalloping on right side of PHOTO, as you pointed out, that could be camouflaged with some soft tissue filler.
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thank you for thinking along. sorry for the bad presentation. I'm not very good at it.
it's also chaos in my head because so much has happened. I don't have the last scan yet because the doctor claims that everything went well. She won't explain to me what happened.
I did indeed have a djs with a genioplasty. they had placed the chin back crookedly and hadn't taken the sides of the jaw which made me feel this. as seen in this scan and Photo.
https://imgur.com/a/d5tAaXq
https://imgur.com/a/g0ivBg3
I then went to Dr defranq for a consultation. He wanted a downgraft upper jaw and a cw setback lower jaw to return to my old face as best as possible. I had then visited a doctor in the Netherlands. she could do the same, she said with a v line (that's what she called it). so apparently she has removed too much of the side of the jaw, so that why my chin is crooked.
as you van see in the picture my lower jaw is too far forward, like a male lower jaw. now I am looking for a doctor who can do the downgraft upper jaw and setback lower jaw for me as Dr Defranq said.If you look at my scan you think it is feasible.
Thanks!
1: I used the scull scan from link https://imgur.com/a/d5tAaXq in my observations which I posted on here.
2:In this thread, I've mentioned that I can't see all IMGUR links (because imgur flashes them for a fraction of a second). So, can't see link https://imgur.com/a/g0ivBg3 and link of DeFranc's simulation. This board allows one to upload photo files directly on here though.
3: The after scans don't really reveal 'removal' to sides of jaw, yet alone 'too much'. They reveal bringing down the chin to BLEND IN with the step offs left by the prior surgery. Unlikely that the scalloped area is from removal. More likely that all could not be blended in perfectly due to prior chin shortenting.
4: Your after scan shows more (a zygomatic osteotomy) than you said you had. There are a lot of screws connecting into the maxilla area in vicinity where another bone cut would be made. In the event your jaw/s looked too forward to you BUT you had 'bimax protrusion' (looks like you could have that), you would probably be dissatisfied with another surgery and I'm disinclined to suggest continued revision surgery.
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You are a very good recipient for learning.
As to the (basic) 'V line' surgery, I go by the KOREAN approach in which they use basic geometrical concepts to change the shape of one figure to another which involves planning types of cuts to displace/remove bone. For the most part, they use sharp cutting instruments for the main shape and reserve burring and/or shaving to later 'round out' residual (or unwanted angularity). I mention that because some surgeons call what they do 'V line' but it is NOT the Korean approach.
Korean approach resolves to solving this basic geometric question which is:
Q: 'Given the wide and blunt chin contour in scull 'a', HOW would you get to the contour of scull 'd' using cuts and bone displacement/removal. Also, WHEN would burring/shaving be used?
A: 'Via a horizontal cut through the (wide) chin and 2 vertical cuts below, spaced a distance apart equal to the excess width. Remove middle segment and move the lateral segments inward to close the gap. Then a straight line diagonal cut from the 'step-off' to the back of the jaw angle. Burring would be reserved for rounding out residual angularity to the posterior jaw for a more (overall) 'rounded' V contour IF all angularity to mandible were to be removed.
------------------------
Now, as to the after scull scan, the surgeon was tasked with UNDOING an overly shortened chin (and calling it a 'V line). Except for the scalloping on right side of PHOTO, as you pointed out, that could be camouflaged with some soft tissue filler.
Thanks for the explanation!