jawsurgeryforums.com
Before/After Photos => Overbites => Topic started by: ForeverDet on July 25, 2014, 03:10:43 PM
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Hey everyone.
This week marks 1 year ago I had surgery with Dr. Gunson. I used to post as reosity on the other forums and I feel like enough time has passed that I can share my experiences and reflect more objectively on my result. I still have a bit of swelling on my right cheek area (if you're looking straight at my face) that will take 6 months to a year to fully resolve. I think listing positive and negatives of the surgery and my feelings about my face is best.
I had long face syndrome as they call it. Class 2 bite, excess incisor exposure, gummy smile, lip incompetence, retruded mandible, steep occlusal plane, etc. I believe my upper jaw was impacted 4-5 mm and lower jaw came forward 11-13 mm. I also had some augmentation with HA done on cheekbones and the right side of my chin were there was an irregularity. Dr. G also removed the plate from the 8 mm genioplasty I had years ago.
I got out of braces mid-April.
Positives:
-Lip incompetence mostly fixed. I had a 11mm inter-labial gap at rest and it's now 4-5 mm. The upper end of normal but acceptable. My chin shows a little visible strain but it's not noticeable to others and I'm fine with it.
-Incisor exposure is normal at 2ish mm. It used to be 7mm.
-Cheek bones are very prominent now which I like although I didn't request this at all at my initial consult. Nice bonus.
-Bite is a solid class 1
-No longer have smallish airway
-Profile is solid, class 1 with a strong chin
-Gummy smile gone yet I still how 1mm or 2mm of gum on full smile. I'm not sure what woo woo magic Dr. Gunson pulled but I had 4mm of gum before surgery and he impacted my upper jaw almost 5 mm so I shouldn't have any gum showing post-op. Yet I do and for future aging that's great. I believe my occlusal plane was flattened from 104 degrees to 94 degrees.
-Everted lower lip is fixed, the posture is normal now
-I didn't have TMJ issues before surgery besides some clicking and still don't have any, knock on wood.
-I had a sliding genioplasty done in 2007 and Dr. G suspected it was contributing to my lip incompetence by pulling down on my lower lip. He removed most of he plate and it seemed to do the trick as my lower lip posture improved. I'm not sure if the plate removal is solely responsible as the mandibular advancement and occlusal flattening can also affect the lower lip.
Negatives:
-God awful recovery. First week was the most uncomfortable and psychologically distressing experience of my life, mostly because I had severe facial swelling outside the normal range. I couldn't even bite down properly the first 2 weeks because my cheeks were so swollen inside my mouth they got in between my teeth. You can see from the photo and that's not even my peak, I got a little bigger a few days after.
-Jawline is more asymmetrical and it's noticeable. Part or perhaps all of it is just my natural bone structure because as my lower jaws were brought forward, the unevenness became more visible. I also developed a callous post-surgery that is apparently contributing to the side of my jaw that's larger. I'm not sure if it's gone or not. I may in the future have an implant put in on my left side to match the right.
-Nose widened at the base 1-2 mm. This is probably my biggest complaint although I'm getting used to it. I may have alar base reduction done in the future.
-Still some residual swelling on my right cheek, very annoying.
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Here's a x-ray from april and a recent pic at a 3/4th angle. I threw in a photo from 4 days post-op but be warned, I looked like a monster.
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Thanks for sharing this. You went into great detail (unlike others who post AMAs here, and disappear after one post). But 1mm gum show is normal. The upper lip descends with wage, so 2mm should make you look younger than you are.
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Thanks for sharing this. You went into great detail (unlike others who post AMAs here, and disappear after one post). But 1mm gum show is normal. The upper lip descends with wage, so 2mm should make you look younger than you are.
No problem. Oh I know 1-2 mm is normal and I like my smile, just strange I have more gum show than expected after 4.7mm vertical shortening of my maxilla. I guess that's due to the unpredictable nature of soft tissue response.
Forgot to post my ortho pics after I got my braces off. My jawline asymmetry is clear here. Also a proper pic of my face before surgery and braces. Note my lips aren't fully relaxed in the before pic as I'm habitually keeping my lips closer together to minimize the inter-labial gap.
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Thank you so much for taking the time to write such a detailed post; that was super helpful!
Sorry, if I missed this, but did you have a multi-segment LeFort or was everything moved in one piece. Also, when you say your lower jaw 'came forward' it was surgically advanced, right? Any rotation? Did he redo your chin or just pull the plate from the prior work?
Thanks again!
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Thank you so much for taking the time to write such a detailed post; that was super helpful!
Sorry, if I missed this, but did you have a multi-segment LeFort or was everything moved in one piece. Also, when you say your lower jaw 'came forward' it was surgically advanced, right? Any rotation? Did he redo your chin or just pull the plate from the prior work?
Thanks again!
You're very welcome. Yes, multi and yes I meant mandibular advancement. I had counter-clockwise rotation of my jaws as my occlusal plane was steep as I mentioned at 104 degrees.
No my chin wasn't touched, just plate removal. The length and shape was good and I had permanent partial numbness from the genio so operating on it again would potentially cause further nerve damage. Actually my entire lower lip and chin is now partially numb. I guess because it doesn't bother me I completely forgot to mention it or put on my negatives list.
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Thanks for the clarification. Glad you're doing well, and thanks again!
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Damn, thats what im worrying about. My surgeon is doing everything he can to prevent my nose from upturning and widening, so I hope it works. I dont think id look horrible with a tiny bit of widening, but the nose upturning thing wouldn't be that great. I dont want to have to get a nose job after this.
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I forgot to ask how much your maxilla was advanced? I saw the impaction movements, but not the advancement.
For whatever it's worth, I think your nose looks completely 100% fine. Looking at your before and after, side by side, sure you can see a difference, but I certainly don't think the after looks bad. It's different, but not worse. Not knowing what you looked like before, if I saw you at the grocery store, I would never even notice your nose.
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I forgot to ask how much your maxilla was advanced? I saw the impaction movements, but not the advancement.
For whatever it's worth, I think your nose looks completely 100% fine. Looking at your before and after, side by side, sure you can see a difference, but I certainly don't think the after looks bad. It's different, but not worse. Not knowing what you looked like before, if I saw you at the grocery store, I would never even notice your nose.
You know I don't know for sure since my surgical plan changed a bit right before surgery but I believe my upper incisor tip came forward around 7mm via counter clockwise rotation. I have the revised ceph tracing with all the numbers but it's in another state :(
Thanks about the nose, I agree it doesn't look bad but I just prefer the width of it before.
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FWIW, if you're not messing about with the bridge and the bones then a rhino isn't that bad. I'm 4 weeks post-op from my closed revision which was just tip work and the swelling is pretty much gone and it wasn't for a couple of stitches messing with the internal healing I'd be just fine
OP, great result, you look really good!
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FWIW, if you're not messing about with the bridge and the bones then a rhino isn't that bad. I'm 4 weeks post-op from my closed revision which was just tip work and the swelling is pretty much gone and it wasn't for a couple of stitches messing with the internal healing I'd be just fine
OP, great result, you look really good!
Why are you doing rhino if you plan on doing upper jaw surgery in the near future?
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Why are you doing rhino if you plan on doing upper jaw surgery in the near future?
Because she's gotta get that damn nose smaller if she is going to get her moneys worth out of the jaw surgery. That's why.
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Got my 1 year pics and x-ray from Dr. G's office
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Last two
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The other thing I was curious about is the HA paste/stuff/material. You mentioned you had it on your cheekbones, and the right side of your chin, correct? I know it's impossible to look at your face now, and assess what it would look like had you gone through surgery, but opted out of HA. What I'm wondering about is how it feels? Is it tight, or unnatural feeling? Do you feel it when you smile, or wash your face? What about when you're sleeping on either your stomach or on your side, and your face is jammed into the pillow?
Thanks again for the detailed posts! You look really good, too. Also, to end up with good joints, and a solid bite...very awesome.
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The other thing I was curious about is the HA paste/stuff/material. You mentioned you had it on your cheekbones, and the right side of your chin, correct? I know it's impossible to look at your face now, and assess what it would look like had you gone through surgery, but opted out of HA. What I'm wondering about is how it feels? Is it tight, or unnatural feeling? Do you feel it when you smile, or wash your face? What about when you're sleeping on either your stomach or on your side, and your face is jammed into the pillow?
Thanks again for the detailed posts! You look really good, too. Also, to end up with good joints, and a solid bite...very awesome.
Thanks!
Right, cheekbones and the right side of my jawline next to the chin although I'm not 100% sure where exactly since it was something the doc decided to during surgery when he saw the irregularity.
All good questions and across board, I don't feel anything unusual. When I touch those areas, it just feels like bone. No tightness during any movement or when sleeping. I guess some people have facial issues with HA but I don't, maybe I got lucky. Only my lips and chin area feel odd because of the partial numbness which I suspect is permanent, it sucks but I don't think about it.
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Found the ceph of my revised surgical plan the day before surgery. My incisor tip actually only came forward 5mm and chin 12.3mm for a grand total of 21mm when you include my past genioplasty.
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Hi, great result. Can you post a picture of what you looked like before the genio. I'd like to see how much difference a movement of 21mm can make to someones face.
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YOu have amazing results. the nose flare and jaw asymmetry are well within normal ranges and you probably notice them far far more than anyone else. Honestly dude, don't do anything about the nose flare. Just get a better haircut. You came out with a 100 percent amazing result, congrats.
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Hi, great result. Can you post a picture of what you looked like before the genio. I'd like to see how much difference a movement of 21mm can make to someones face.
Thanks I don't have a proper one with relaxed lips but here you go.
And thanks Lazlo. Except the hair cut comment, I like my hair like that :D altho I actually just got it cut in a kind of undercut style.
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Dude you have an amazing result and you look much much better.
I'm just curious, why does the upper lip elongate so much with jaw surgery? I mean even in your case, your upper lip could have retained the slightly c-shape or concave quality it had before the jaw surgery that would have been nice. It just ages one terribly when the angle is more obtuse. f**king sucks --not for you you look fine, but for me it would make me look much much worse, and i've already lost my concave shape due to ortho --extractions.
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Dude you have an amazing result and you look much much better.
I'm just curious, why does the upper lip elongate so much with jaw surgery? I mean even in your case, your upper lip could have retained the slightly c-shape or concave quality it had before the jaw surgery that would have been nice. It just ages one terribly when the angle is more obtuse. f**king sucks --not for you you look fine, but for me it would make me look much much worse, and i've already lost my concave shape due to ortho --extractions.
Hmm I would say jaw surgery doesn't really elongate the upper lip so much as create the illusion it's longer unless of course pre-surgery your still growing so after when your compare, your lip is actually longer. In my case, my upper lip just looks longer because the hard tissue behind it was shortened and advanced. So my upper incisor exposure was normalized and my upper lip now has more support because it's touching my incisors. Before I had a huge inter-labial gap and the upper lip just sort of hung with air behind it so it looks shorter and more acute.
But yeah for sure everyone loses soft tissue support do to aging so there's that lengthening and thinning of the upper lip but I don't think jaw surgery really causes that pre-maturely unless your have maxillary retraction AND impaction done which is almost never indicated. I saw a case of a young women where the dumbass doctor moved the maxilla back and it aged her horribly. I mean she looked 70 ears old in her profile because her upper lip was now super thin and angled inward, so obtuse.
Thanks again for the positive comments.
EDIT: Technically there is a lengthening of the philtrum height usually during impaction i.e. the middle part of the lip becomes longer relative to the commissure height (the length of the edge of the upper lip relative to the lower lip). When you have zero incisor exposure at rest, your philtrum height and commissure height are equal. Aesthetically by itself, no tooth display at rest isn't necessarily unattractive or makes you look older as there are innumerable examples of youthful and hot people with no tooth display in repose. But combined with other traits like thin lips, insufficient tooth display when smiling, etc. then it can become aesthetic issue and make you look pre-maturely aged.
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This might just be my perception of things, but in your smile pics, your lower lip seems kinda high up even as its supposedly pulled down. Was your smile really similar to that before surgery, or was it caused maybe by the SG? I do see how the ceph tracing would position your resting lower lip much higher than before, so maybe that has something to do with it.
I ask because I've seen several smiles from bimax surgery that come out looking similar to yours, and wondering if that's an (unfortunate?) consequence of the surgery. Like does the lower lip not go down enough to even reveal your lower gums if you wanted to??
I'm the token botched 'smile' patient (from a stupid chin implant no less), so this is maybe of much more interest to me than it is to others.
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How much did it cost all up?