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Aesthetics / Re: BSSO or Bimax? Surgery Soon
« Last post by kavan on March 16, 2025, 03:44:26 PM »NOTE: IMGUR blocks my seeing all the images by putting up videos of girls making disgusting confections that look bloody brains. So,limited feedback from me to queries dependent on IMGUR links.
I managed to copy a document called Plan (alpha) Triple Jaw; the (read-out) DISPLACEMENT PROPOSAL as to look at it while I post my response. I also got a quick look at your face. By the time you see my post, I will have deleted the displacement read-out proposal of plan alpha triple jaw. But I have the following to say about it:
'Triple Jaw': WTF??? there are only 2 jaws; upper and lower. The correct terminology for the surgery is DOUBLE JAW SURGERY with GENIOPLASTY.
ANS: The 3mm displacement is purely horizontal which is not too much of a 'bad' thing. 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. The read out tells you the 3mm are in A-P direction and there is 0 down-up movement. So, displacement is purely horizontal. There is NO 'UP' (or 'down') vector component of your read-out chart. So, nothing in it that conveys IMPACTION or a turn UP to the nose.
As to the nose base getting a little wider, a good maxfax will do something called an 'alar cinch' to mitigate that. As to the foregone conclusion that 'all noses will look worse' after maxillary advancement, it's usually a KNEE-JERK one because all noses don't look worse after maxillary advancement. It depends on the angle of inclination the nose base is advanced over.
The possibilities of an unfavorable aesthetic outcome to the nose can increase when advancements are very large and also over an unfavorable inclination of the maxilla. But to keep it simple, it's mostly a problem for people who START OUT with good nose aesthetics or would OTHERWISE NOT have needed nose correction before any jaw surgery. So, personally, I fail to see the reasoning behind 'risk avoidance' of possible nose sequella when your start point for the nose is that you would benefit from some nose improvement (rhino) whether or not you had jaw surgery and also when the angle of inclination the 3mm advancement is taking place over is ZERO.
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. Keep nose as is (via no maxillary advancement) = possibility of under correction of lower jaw. I mean if you want to look better, BOTH your nose and lower jaw need to be corrected. So when you forfeit the extra jaw advancement you could have to keep the nose the same, you're still left with a nose needing correction but also under correction of lower jaw. I don't know where the logic of that type of decision comes from. Probably none of my business. Just sayin' it would not be my own.
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.
2: Look at the POG POINT part of your chart. The displacement at the POG point tells you what the final advancement of the lower jaw (including the chin) is. The A-P direction is the HORIZONTAL displacement which is 11.4mm and the 'up/ down' part tells you, the chin point is going vertically up a little. It's also implicit that the advancement at the POG point is a function of the A-P advancement to the ANS point of UPPER jaw. So, the displacement read-out chart conveys that a purely horizontal advancement of the ANS, allows for the POG point to be advanced 11.4 mm horizontally and .6mm vertically upward. So, NO IDEA where you come up with a lower jaw advancement of '14mm'.
3: There is NO anterior impaction on the (alpha) Triple Jaw displacement read-out. The ANS section of your displacement proposal reads 0= NO upward movement of the ANS. So, NO IDEA where you conclude any anterior impaction to remind the surgeon you want 'minimum' because the chart read 0.
4: The KEY points to understand on a DISPLACEMENT PROPOSAL chart are: ANS, PNS and POG and the 'up' and 'down' measures of those things. ANY movement along a DIAGONAL path will have both a VECTORIAL vertical (up or down) and horizontal displacement (A-P direction). If the displacement path is purely horizontal there will be NO=0 vertical upward or downward displacement.
In closing, I don't see any basis for the conclusions you are coming up with, and it's not clear you understand the very basics of what the displacement chart is conveying when you think it's telling you you are getting an impaction that your doctor needs to 'minimize' where 0 impaction can be read from the read out or 14mm lower jaw advancement from it when the pog point doesn't convey that or that your nose will be 'upturned' when the read out lists a 0 upward vectorial displacement of the nose.
I managed to copy a document called Plan (alpha) Triple Jaw; the (read-out) DISPLACEMENT PROPOSAL as to look at it while I post my response. I also got a quick look at your face. By the time you see my post, I will have deleted the displacement read-out proposal of plan alpha triple jaw. But I have the following to say about it:
'Triple Jaw': WTF??? there are only 2 jaws; upper and lower. The correct terminology for the surgery is DOUBLE JAW SURGERY with GENIOPLASTY.
ANS: The 3mm displacement is purely horizontal which is not too much of a 'bad' thing. 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. The read out tells you the 3mm are in A-P direction and there is 0 down-up movement. So, displacement is purely horizontal. There is NO 'UP' (or 'down') vector component of your read-out chart. So, nothing in it that conveys IMPACTION or a turn UP to the nose.
As to the nose base getting a little wider, a good maxfax will do something called an 'alar cinch' to mitigate that. As to the foregone conclusion that 'all noses will look worse' after maxillary advancement, it's usually a KNEE-JERK one because all noses don't look worse after maxillary advancement. It depends on the angle of inclination the nose base is advanced over.
The possibilities of an unfavorable aesthetic outcome to the nose can increase when advancements are very large and also over an unfavorable inclination of the maxilla. But to keep it simple, it's mostly a problem for people who START OUT with good nose aesthetics or would OTHERWISE NOT have needed nose correction before any jaw surgery. So, personally, I fail to see the reasoning behind 'risk avoidance' of possible nose sequella when your start point for the nose is that you would benefit from some nose improvement (rhino) whether or not you had jaw surgery and also when the angle of inclination the 3mm advancement is taking place over is ZERO.
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. Keep nose as is (via no maxillary advancement) = possibility of under correction of lower jaw. I mean if you want to look better, BOTH your nose and lower jaw need to be corrected. So when you forfeit the extra jaw advancement you could have to keep the nose the same, you're still left with a nose needing correction but also under correction of lower jaw. I don't know where the logic of that type of decision comes from. Probably none of my business. Just sayin' it would not be my own.
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.
2: Look at the POG POINT part of your chart. The displacement at the POG point tells you what the final advancement of the lower jaw (including the chin) is. The A-P direction is the HORIZONTAL displacement which is 11.4mm and the 'up/ down' part tells you, the chin point is going vertically up a little. It's also implicit that the advancement at the POG point is a function of the A-P advancement to the ANS point of UPPER jaw. So, the displacement read-out chart conveys that a purely horizontal advancement of the ANS, allows for the POG point to be advanced 11.4 mm horizontally and .6mm vertically upward. So, NO IDEA where you come up with a lower jaw advancement of '14mm'.
3: There is NO anterior impaction on the (alpha) Triple Jaw displacement read-out. The ANS section of your displacement proposal reads 0= NO upward movement of the ANS. So, NO IDEA where you conclude any anterior impaction to remind the surgeon you want 'minimum' because the chart read 0.
4: The KEY points to understand on a DISPLACEMENT PROPOSAL chart are: ANS, PNS and POG and the 'up' and 'down' measures of those things. ANY movement along a DIAGONAL path will have both a VECTORIAL vertical (up or down) and horizontal displacement (A-P direction). If the displacement path is purely horizontal there will be NO=0 vertical upward or downward displacement.
In closing, I don't see any basis for the conclusions you are coming up with, and it's not clear you understand the very basics of what the displacement chart is conveying when you think it's telling you you are getting an impaction that your doctor needs to 'minimize' where 0 impaction can be read from the read out or 14mm lower jaw advancement from it when the pog point doesn't convey that or that your nose will be 'upturned' when the read out lists a 0 upward vectorial displacement of the nose.