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I'm considering bimax surgery for cosmetic reasons.

I went to the orthodontist today and was able to get a CBCT scan done. They let me take pictures of it.

Here's a link to a photo gallery with my CBCT scans and facial photos:
https://imgchest.com/p/ljyqdonne72

The first 2 photos are side view / front view from the CBCT scan. The last 2 photos are side view / front view of myself, taken with my phone camera.

The orthodontist noted that I have:

• "vertical maxillary deficiency"
  "midline deviation"
  "moderate" overcrowding of the upper teeth
  "severe" overcrowding of the lower teeth
  "overjet"

I've asked other people about this and they all tell me that I have "short face syndrome". Apparently, one of the dead giveaways of "short face syndrome" is that your upper teeth are not completely exposed when smiling. Whenever I smile, only the bottom half of my front teeth are visible, and my mouth takes on the shape of a trapezoid, instead of a crescent. Downgrafting would presumably push my maxilla downwards, which would expose my upper teeth, and change the shape of my smile.

Here is a link to 2 photos of my teeth when smiling:
https://imgchest.com/p/qe4graa9oyj


My chin is weak when viewed from the side, but when I'm "jutting", i.e., pushing my jaw forwards as far as possible, it massively improves my appearance.

Here's a link to 2 photos of myself from the side, demonstrating how jutting improves my side profile:
https://imgchest.com/p/n87wrarbqyx


I've learned so far that I would need to advance my mandible, as well as downgrafting the maxilla to improve my upper tooth show.

What I can't seem to find out is if I should try to get a linear advancement of both jaws, or CCW advancement.

My end goal is a face that is vertically lengthened and forward-grown in appearance, that looks natural and harmonious.

Thank you.

Part 1.

RE: 'Other people told me I had short face 'SYNDROME'.

Looks like these 'other people' don't distinguish between a syndrome and a cosmetic issue.

The key word here is 'COSMETIC' as in 'for COSMETIC reasons'.
The key word here is NOT 'SYNDROME' as in 'short face syndrome'.

In terms of linear distance relationships where (horizontal) lines are drawn through some select landmarks of the face and the (vertical) distance between the parts is looked at (division of '1/3rds'), you have pretty much 'equal' divisions.

In terms of the frontal view, subjectively, you look pretty good and you also would/could/do pretty good to yourself when jutting out your jaw. So, on a spectrum of 'funny looking' to 'attractive', you veer on the attractive side. A SYDROMATIC person would veer more in the direction of 'funny looking' than 'attractive'.

In terms of both QUANTITATIVE (objective) distance relationships and also QUALITATIVE (subjective) impressions, you are NOT 'sydromatic'. Having a cosmetic issue that could be improved on (via maxfax surgery) does NOT mean the issue is within the spectrum of 'syndromatic'.

The ortho's assessment as to the deficiency, deviations and issues with the teeth as it relates to the smile is correct. But that does NOT confirm what WTF these 'other people' assess to the spectrum of 'syndromatic'.

So, I want to get THAT part out of out of your head before I give my take.
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Part 2:

RE: '...should I try to get a linear advancement of both jaws, or CCW advancement.'

I can't answer the question as you ask it. Because, although you SAY you 'understand' you need a MAXILLARY DOWNGRAFT, if you really understood you needed a maxillary downgraft, linear advancement would not be one of the choices to ask about BECAUSE linear advancement doesn't include any downgrafts. It just advances both jaws pretty much equally.

What I CAN say here is that you would benefit from a MAXILLARY DOWNGRAFT, in particular, the type that downgrafts the OVERALL maxilla which pushes the whole thing down in which there is MORE upper tooth show (the entire upper arch) and a longer lower '1/3rd' of the face so the lower jaw area and the chin cast longer on the face. Hence, although you don't have 'short face SYNDROME', cosmetically, you would look better with a longer lower 1/3rd.

An OVERALL maxillary downgraft elongates the ENTIRE maxilla and increases the vertical length of the face whether or not it has 0 rotation or 'net' CCW or CW. For example a 0 rotation overall maxilla downgraft elongates the entire lower '1/3rd' of the face and so do overall maxillary downgrafts with either net CCW or net CW. They ALL address the goal of more vertical length.

A 0 rotation overall downgraft would elongate down equally. One with 'net' CCW rotation would benefit someone needing more 'uptilt' to the chin area and one with net CW rotation would benefit someone needing more 'down tilt' to the chin. Although all will vertically elongate the lower face/ chin area by pushing the area down from above, the choice of net rotation would depend on whether or not the person would benefit more from more of an uptilt to the chin or a down tilt. It would also depend on whether or not the person needed a an uptilt or down tilt to the upper front teeth. Since, your chin already is in an uptilt position and your front upper teeth have an OVERJET, double jaw advancement over a  a net CCW-r could exaggerate that. An overall max-downgraft with net CW would give the chin more a a down tilt and also decrease the overjet. It would address/correct the ORIENTATION of both the maxilla and mandible and also your goal of more lower face elongation.

The entirety of the surgery would include advancement of both jaws in addition to DROPPING THEM DOWN FROM ABOVE (overall maxillary downgraft) AND correcting the bite/teeth. So, I do think net CW-r would work better for you because both the teeth AND the chin get a down tilt with the net CW- overall maxillary down graft. That is to say, advancement of both jaws would look better on you if the overall maxillary downgraft was a net-CW.

Also, your photo of 'jutting out your jaw' looks more like a morph than a jut. Either way, neither a morph nor a jaw jut predict surgery outcomes. But it does convey you would look better with both vertical elongation of the lower '1/3rd' of the face in addition to lower jaw advancement. Since your chin is tipped up in the before and tipped down in the after, that jives with what I said: 'overall maxillary downgraft with net CW-r'.

Hence your question of: '..should I try to get a linear advancement of both jaws, or CCW advancement.' can't answered as you ask because the solution involves NEITHER CCW-r nor linear advancement. It involves an overall  maxillary down graft (that spans the entire maxilla) and one with net CW-r.

Don’t do it you will look weird when smiling and talking I had unnecessary anterior impaction and I’m needing revision to bring some tooth show back

my advice would be to establish beforehand whether or not the surgeon performs the 'high lefort 1'. If not, than POOF goes the cost of the consult

Solid advice. Thanks Kavan! Somehow, without hearing it here, I probably would have overlooked this and wasted some money on consults that would have been dead-ends.

Thanks again Kavan. While I realized I only got that treatment plan documented because of insurance, I really took everything in there at face value, and didn't ever consider the 'wiggle room' scenario for getting insurance to potentially go for it - too bad they still didn't budge. Also thank you for your opinion on his treatment plan overall; I am keeping this original plan in mind as I go seek out a surgeon to work with, and hoping the 'high lefort' is not too much of a rarity outside of his former practice.

Hi Kavan, thanks for the rundown and the example to demonstrate it! And as for the questions you had for me:

1. I was not a minor when I consulted.
2. I was looking to get the surgery at least partially covered by insurance since I couldn't afford the full price tag of surgery back then.

Unfortunately, insurance fully denied the coverage request and deemed this as an elective/cosmetic-only procedure, and I was too stupid at the time to realize I had options to get a loan or finance the surgery, so I never went through with it, which I regret as it's 6 years later now and also that doctor has retired. Seems like insurance coverage for me will never be an option, but I've since (somewhat) overcome the financial barrier between myself and these procedures, which is why I'm starting to reinvestigate my situation and try to get some new consultations booked, but I'm also trying to understand the geometric side of all of this myself so I can better understand my current bone jaw/teeth and also the outcome of any treatment plan.