Hey kavan! Thank you for putting it so plainly. (Also that’s regrettable about the brain confections…)
For example, doctors who do the CCW via posterior downgraft often want to set the displacement vector of the ANS to pure horizontal line because the unfavorable nose base aesthetics can arise from displacement over a DIAGONAL line.
So, personally, I fail to see the reasoning behind 'risk avoidance' of possible nose sequella when . . . the angle of inclination the 3mm advancement is taking place over is ZERO.
This is a very interesting insight I hadn’t heard before. The common belief often touted is “maxilla moving forward = nose widening and upturning”. But understanding how the
direction of movement does (or does not) cause change is appreciated, thank you.
As to the nose base getting a little wider, a good maxfax will do something called an 'alar cinch' to mitigate that.
The surgeon confirmed in our initial consult that he does indeed use an alar cinch. He mentioned that it doesn't prevent all widening, so my concern was regarding widening my already wide nose. On that note...
A decision to KEEP your nose AS IS resolves to a decision to forfeit the extent of the lower jaw advancement you could get in a circumstance where the lower jaw recession is the GREATER of your aesthetic problem. So, right there, acting on knee jerk RISK AVERSION that your nose base could get a little wider blows your chances of getting a good jaw advancement when the jaw recession is the BIGGER aesthetic problem. So, the nose will REMAIN an aesthetic problem in its own right if you choose to keep as is and also forfeit getting a good lower jaw advancement to do so.
I think these are tough words that I needed to hear. I realize my nose is also an issue, but my thinking was that opting for a slightly less optimal jaw surgery plan might prevent it from getting even worse. If it did worsen, it could push the issue over the edge, making rhinoplasty feel unavoidable, while right now, my nose might not be “bad enough” to justify surgery and could still be lived with (although, from what I'm gathering, it seems like my current nose may be even worse than I initially thought).
It seems like not going all the way with this jaw surgery is a lost opportunity, and perhaps I should figure out a way to make this rhinoplasty happen. (Maybe I'll start with an alarplasty, a minor procedure that's cheap and done under local anesthesia, while I save up for a rhino if the alaraplasty improvements prove insufficient.)
NOW, BACK TO THE READ OUT CHART.
1: The doctor who claims you have 'THREE' jaws (just LOL) doesn't list the PNS on the chart. When CCWA-r via posterior downgraft is in the cards the PNS point (posterior nasal spine) is listed with a downward movement. So, there is no information on that.
I spoke with the surgeon today, and it seems like he's hesitant to do the original CCW w/ posterior downgraft plan unfortunately. He did mention there'd be some CCW rotation with the lower jaw too though.
So, NO IDEA where you come up with a lower jaw advancement of '14mm'.
Yes, sorry for the confusion. The 14mm vs 17mm values were what the doctor had told me originally, but it seems these values changed when it was put into this visualization software. I shouldn’t have assumed the values stayed the same, and should’ve checked the document closer.
So, NO IDEA where you conclude any anterior impaction to remind the surgeon you want 'minimum' because the chart read 0.
Again, this is an issue that arose due to me just assuming things were the same based on the conversation I previously had with the surgeon a few months ago, very sorry about that.
Overall, it seems like my concerns with the surgeon’s proposal are unfounded, so I think I will be proceeding with this 'Triple Jaw' (
) plan. He mentioned he could also increase the genioplasty from 5mm to 6–7mm, so I’ll probably do that too. Thank you as always kavan, I hope you realize how much of an impact this has had on my decision-making. Much appreciated!
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