jawsurgeryforums.com
General Category => Aesthetics => Topic started by: Tati on November 13, 2017, 03:38:21 PM
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Hi everyone,
I'll make this brief, I'm seeking revision and was suggested an anterior downgraft by a local surgeon to improve teeth show (my upper teeth show about a mm when I smile big).
I sent him scans and am waiting for a proper proposal before sharing any photos or asking for personal advice.
In the meantime, I wanted to know if someone could mention what sort of changes can be expected from said movement, and also ask if anyone out there has photos of cases or are willing to share their own.
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Clockwise rotation of the mandible given the mandible rotates in same direction as maxilla.
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You could have an alternate operation of a upper lip lift, less invasive and costly. Another alternative is advancement of both jaws, as every 3mm advancement gives you 1mm more tooth show, due to the elastic nature of the upper lip.
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Hi everyone,
I'll make this brief, I'm seeking revision and was suggested an anterior downgraft by a local surgeon to improve teeth show (my upper teeth show about a mm when I smile big).
I sent him scans and am waiting for a proper proposal before sharing any photos or asking for personal advice.
In the meantime, I wanted to know if someone could mention what sort of changes can be expected from said movement, and also ask if anyone out there has photos of cases or are willing to share their own.
Aesthetically, it's likely the philtrum area will elongate a bit with CW rotation.
Your airway will likely get smaller as the lower jaw moves back.
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Thanks for the info everyone!
My maxilla was advanced 10mm and my jaw 5mm (was class III) in a previous surgery. Airway space wasn't an issue before, much less now.
I actually want the subsequent setback that comes with CW, given I don't like how advanced my lower third is and the smile is somewhat unnatural.
Maybe my question should have been if these aspects could improve to a certain degree.
Concerns in mind would be a steep jaw angle and more strain on the chin.
Also note, before any procedure, even if I lifted the upper lip all the way up, I couldn't begin to see my gums (in case anyone is wondering how a maxilla could be advanced so much, and result in little to no teeth show).
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Another functional concern is that, since surgery, if I laugh a lot or smile for a while, my nasal base begins to hurt and soon after that my septum.
Does anyone have a clue what it might be?
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Here's a recent ceph..
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Thanks for the info everyone!
My maxilla was advanced 10mm and my jaw 5mm (was class III) in a previous surgery. Airway space wasn't an issue before, much less now.
I actually want the subsequent setback that comes with CW, given I don't like how advanced my lower third is and the smile is somewhat unnatural.
Maybe my question should have been if these aspects could improve to a certain degree.
Concerns in mind would be a steep jaw angle and more strain on the chin.
Also note, before any procedure, even if I lifted the upper lip all the way up, I couldn't begin to see my gums (in case anyone is wondering how a maxilla could be advanced so much, and result in little to no teeth show).
Subsequent CW rotation to lower jaw is back and down. Make sure you understand the 'set back' aspect you want comes with downward aspect too. Your concerns are consistent with basic geometry concepts that apply to rotations. The inclination of the mandibular plane would increase in steepness consistent with the degree of CW rotation. With that, the chin orientation displaces back and down as in more angled away from a vertical where more 'effort' would be needed to lift the lower lip UP.
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Not sure if CW is a good idea in your case - your occlusal plane is moderately steep as it is. How long is your upper lip? It seems to be folding over your lower lip.
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I understand there's a give and take with most anything, which is why I'm not completely sold on the idea.
As far as lip length, I can say I have very plump lips and my philthrum is short-ish, per what I see in the mirror.
I can touch the tip of my nose with my tongue and still have trouble reaching the upper part of my teeth with a toothbrush, specially where the anterior nasal spine lies. It's tough to imagine room for a lip lift.
- The photo is the bottom half of my face. I had a plate removed last week which caused the swelling and bruising seen on one side.
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Normal distance relationships from the front. Balance of '1/3rds'
Chin area will project longer with (back and down) CW.
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So, bad idea?
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So, bad idea?
It's not an idea, good or bad. It's a concept where some understanding of basic geometry is needed to embrace it. Your wanting to increase tooth show by increasing the angle of the occlusal plane, will in turn increase angle of of mandibular plane and in turn, the rotation rotates chin back and down where you would see the downward displacement of the rotation as a 'longer' chin in frontal view.
The concept to understand is that CW rotates backwards and down and that your request for wanting to do that for the PROFILE resolves to one where you are also asking for your chin to project a little longer in frontal view.
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I understand the concept of rotating, though was unaware it made your chin alone appear longer.
I figured you were saying it would make the front disproportionate in some way, or give me a long face.
My concern is not profile AT ALL to be clear, it's three-quarter and frontal view.
Anyhow, the surgeon said he'll see what can be done. He might suggest other movements, he might say there's nothing to be done, or he might just offer CW and leave me to evaluate the pros and cons..
I'll update as I recieve an answer..
I appreciate your feedback.
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I understand the concept of rotating, though was unaware it made your chin alone appear longer.
I figured you were saying it would make the front disproportionate in some way, or give me a long face.
My concern is not profile AT ALL to be clear, it's three-quarter and frontal view.
Anyhow, the surgeon said he'll see what can be done. He might suggest other movements, he might say there's nothing to be done, or he might just offer CW and leave me to evaluate the pros and cons..
I'll update as I recieve an answer..
I appreciate your feedback.
The easiest way to conceptualize a rotation is to look at a clock. Let's say the big hand is on 3. Extrapolate a straight horizontal from there. Let the big hand rotate to 6. Extrapolate a straight line horizontal from there. The horizontal extrapolated from 6 will be lower than the horizontal extrapolated from 3.
The next part is kind of hard for some people but if you can conceptualize (rotate in your head) the clock 90 degrees away from the plane you are used to viewing the clock as to project the extrapolation lines on to a 2-d plane, you won't see the lines but only the points where they hit the plane. The point where the '6' line hits plane will be lower than where the point of '3' line hits the plane.
The clock as you are used to looking at one, is equivalent to 'profile' of face with regard to rotations. The rotation of the clock itself 90 degrees away from the plane you are used to looking at it would be the 'frontal' view.
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Ok, I understood everything except the second paragraph.. and I will try again to make something out of it
If I drop my jaw and sort of stretch out the midface, I don't dislike the result, in fact, I prefer it.. it's just difficult to know how reliable that is
The big question mark is always soft tissue.. I've seen the lower third flatten and nasolabial folds improve, which would make sense? I'm not sure what else could occure. For example, with advancement my cheeks dropped from the upper midface all the way down next to my mouth.
There are subjective issues as well, like the fact I look "harsher" after surgery. and I remember thinking I looked less caucasian.
Harsher can't really be measured, but the look I dislike I see on people with either big or unnecessary advancements and/or impactions, so I save hope.
As far as caucasian features go, I've seen skulls compared and the european has a longer face and less advanced lower third, explaining what I noticed.
I'm curious if anything happens to the nose as well.
Now excuse me for reading too much into things, but I'm terrified of doing the wrong thing (AGAIN) and can't simply trust. :'(
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Ok, I understood everything except the second paragraph.. and I will try again to make something out of it
If I drop my jaw and sort of stretch out the midface, I don't dislike the result, in fact, I prefer it.. it's just difficult to know how reliable that is
The big question mark is always soft tissue.. I've seen the lower third flatten and nasolabial folds improve, which would make sense? I'm not sure what else could occure. For example, with advancement my cheeks dropped from the upper midface all the way down next to my mouth.
There are subjective issues as well, like the fact I look "harsher" after surgery. and I remember thinking I looked less caucasian.
Harsher can't really be measured, but the look I dislike I see on people with either big or unnecessary advancements and/or impactions, so I save hope.
As far as caucasian features go, I've seen skulls compared and the european has a longer face and less advanced lower third, explaining what I noticed.
I'm curious if anything happens to the nose as well.
Now excuse me for reading too much into things, but I'm terrified of doing the wrong thing (AGAIN) and can't simply trust. :'(
Well, it's hard to describe how to rotate something in one's head.
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If I drop my jaw and sort of stretch out the midface, I don't dislike the result, in fact, I prefer it.. it's just difficult to know how reliable that is
OK. Forget about the part where you stretch out your midface. But relate the jaw movement to the type of rotation you are doing.
The big question mark is always soft tissue.. I've seen the lower third flatten and nasolabial folds improve, which would make sense? I'm not sure what else could occure. For example, with advancement my cheeks dropped from the upper midface all the way down next to my mouth.
Re-evaluate your observational skills and cross reference them with what lefort 1 advancment actually does. Does it actually 'lower' cheeks or do they just look less prominent when the area below them is advanced out?
There are subjective issues as well, like the fact I look "harsher" after surgery. and I remember thinking I looked less caucasian.
Harsher can't really be measured, but the look I dislike I see on people with either big or unnecessary advancements and/or impactions, so I save hope.
As far as caucasian features go, I've seen skulls compared and the european has a longer face and less advanced lower third, explaining what I noticed.
I'm curious if anything happens to the nose as well.
Now excuse me for reading too much into things, but I'm terrified of doing the wrong thing (AGAIN) and can't simply trust. :'(
As far as Caucasian skulls go, were you looking at the dolichocephalic, brachycephalic or mesocephalic. Which of the MANY sub-groups of European were these skulls?
Which category does your cephalic index fit into, dolio,brachy or meso? Basically, were you looking at skulls of the same cephalic type as your own?
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You don't have to answer these questions to ME. But if you can't answer them to YOURSELF, it's prudent to be cautious about what assumptions you're making in the decsision making process.
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Easy to answer..
I stretched the philthrum area to imagine it longer only. Since it's impossible to simulate a maxilla going down and inward, I know it's not even close to exact.
Lefort 1 made my zygomatic bone less prominent, though the actual fat from my cheeks was dragged down..
As far as ethnicties, I'm not concerned with the result looking any particular way.. it was an observation based on what's likely no more than a stereotype in mind..
I guess there are also blacks with longer, leaner faces and others with really prominent maxillas.
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Easy to answer..
I stretched the philthrum area to imagine it longer only. Since it's impossible to simulate a maxilla going down and inward, I know it's not even close to exact.
Lefort 1 made my zygomatic bone less prominent, though the actual fat from my cheeks was dragged down..
As far as ethnicties, I'm not concerned with the result looking any particular way.. it was an observation based on what's likely no more than a stereotype in mind..
I guess there are also blacks with longer, leaner faces and others with really prominent maxillas.
Well, (with the exception to the Lefort 1 question) you didn't answer the questions as asked. It was easier for you not to.
An appropriate answer for some of them actually would be; 'I don't know'.
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Yeah, I don't know the last one and honestly didn't even intend to come across as if I had that much of a clue..
I simply remember having the thought of looking less caucasian in the beginning months post-op. When I saw the photo of the skulls (by chance, for something unrelated to this), it seemed to make sense it would be that way considering the movements I had done..
The fact I thought something looked more or less white, black, asian, aboriginal, etc. had to be based on a stereotype image of each as a whole. It was a general impression, nothing more. I hadn't even stopped to think of variations within ethnicities (hey, clueless me) or analyzed anything in detail/proportion-wise.
Regarding "relating the jaw movement to the rotation you're having".. the only relatively precise thing you can do is drop your jaw a bit and observe how it looks going down and back. I wrote in a previous comment I had done that and think it looks better. I actually don't hate my genio after the fact.
In clarifying the part about stretching the philthrum, it was so you wouldn't get the impression of me trying to make exact predictions off of it.
I've seen photos where after impaction, the philthrum and face as a whole look bigger. I would assume it's because the lower third moved closer to the eye of the observer, since technically there's less bone. That being said, I'm unsure whether downgrafting produces the immediate opposite outcome.
Back to Lefort 1, I've witnessed other people with large maxillary advancements have a same effect on their soft tissue, other than easily spotting it in before/after photos of myself.
When writing "easy to answer", I had the latter aspects in mind..
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I would not expect you to know the answers to the skull questions, cephalic groups of such.
Here is photo of girl who's actually from Caucasia, the country,Georgia. https://i.pinimg.com/736x/b4/55/c7/b455c7206c27e24a506c16ed4398ccd7--beautiful-little-girls-beautiful-children.jpg
Anterior impaction, (when done for VME) lets the lower jaw swing up and out (CCW) to come more forward to the viewers eye whereas when the CW of the VME swung it down and back, it was further away from viewers eye. Anterior downgrafting would tend towards the opposite; jaw swinging CW--down and back.
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your philltrum is fine and won't elongate since your soft tissue seems very firm. I would however get a slight lengthening genioplasty. Your chin seems a bit "squashed" and I think an elongating genioplasty would make your jawline and chin appear more elengant. There's nothing wrong with a strong chin on a woman. In fact look at Jessica Chastain and Julianne Moore --their chins are amazing.
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I would not expect you to know the answers to the skull questions, cephalic groups of such.
Here is photo of girl who's actually from Caucasia, the country,Georgia. https://i.pinimg.com/736x/b4/55/c7/b455c7206c27e24a506c16ed4398ccd7--beautiful-little-girls-beautiful-children.jpg
Anterior impaction, (when done for VME) lets the lower jaw swing up and out (CCW) to come more forward to the viewers eye whereas when the CW of the VME swung it down and back, it was further away from viewers eye. Anterior downgrafting would tend towards the opposite; jaw swinging CW--down and back.
I used 'caucasian' as synonymous with 'white'. That littlle girl would fit right in where I live, though.
I'm aware anterior impaction and anterior downgrafting are technically exact opposites movements, what makes me wonder is whether the nose and soft tissue respond in nearly exact opposite ways.
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your philltrum is fine and won't elongate since your soft tissue seems very firm. I would however get a slight lengthening genioplasty. Your chin seems a bit "squashed" and I think an elongating genioplasty would make your jawline and chin appear more elengant. There's nothing wrong with a strong chin on a woman. In fact look at Jessica Chastain and Julianne Moore --their chins are amazing.
Looking back, the women I'd consider most beautiful all have strong chins. Jessica being one.
The thing is, you have to take face and chin shape into account..
If the angle of my jaw becomes steeper, would a lengthening genio be a good idea then (aesthetically)? .. I really don't know.
I have strain on my chin, still, after surgery. I'm not sure if the problem is scar tissue, plates, or down right bone..
I would agree to it in a heartbeat for the functional aspect, at this point..
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I used 'caucasian' as synonymous with 'white'. That littlle girl would fit right in where I live, though.
I'm aware anterior impaction and anterior downgrafting are technically exact opposites movements, what makes me wonder is whether the nose and soft tissue respond in nearly exact opposite ways.
When ever I read people mention Caucasian, skulls with 'longer' faces they have seen (somewhere), they're usually referring to Nordic or Anglo-Saxon or skulls closer to the dolchioceph range than the brachioceph range. Also, people with extremely dark skin who aren't often called 'white' are Caucasians. Eg. people from India.
The closest prediction of anticipated changes are seen on a ceph displacement diagram where the max fax not only tells you he can give you anterior downgraft but shows you a proposal of the profile changes. A ceph displacement proposal is basically 2 contour tracings shown on the same diagram.