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Sorry, I can't keep track of which plan is which when plans are not all together on the same page and described.

I'm just saying that I think your nose would also benefit by some modest maxillary advancement. You have a slightly convex (slightly) and slightly downward rotation of the tip and the dorsum of the nose stands to get somewhat straightened out and the tip somewhat de-rotated with maxillary advancement. That is to say, in PROFILE perspective, your nose contour is consistent with what you say you have and what other doctors said you had which was somewhat of a recessive maxilla. Also, since you now say that your nose is NOT wide at the alar base, all that is CONSISTANT  with my saying I think your nose would veer in direction of benefit vs detriment--and YES, an alar cinch can be used to mitigate excess unwanted width. If you had a conCAVE nose (a dip in the dorsum) and a turned up tip, that's the type of nose that can experience un aesthetic sequella with maxillary advancement. OK.

CCW-r is associated with getting a larger lower jaw advancement than you would otherwise get without CCW-r assuming the CCW-r in question is a posterior downgraft. If the rotation point is at the ANS, that type of rotation doesn't affect the upper tooth show. The type of CCW-r that can affect the upper tooth show in the sense that it REDUCES a gummy smile is anterior impaction; a slice removed from the anterior maxilla. However, what can increase the tooth show (or gum show) is the maxillary advancement. So, if you want more of a lower jaw advancement than you would get WITHOUT CCW-r posterior downgraft than you would have to weight that in with the possible trade-off of more gum show with the maxillary advancement. So, I would say, the maxillary advancement would benefit your nose profile contour and the cut to do it would allow for CCW rotation to get a good lower jaw advancement. So, you would have to decide if the 2 possible 'pay offs' are worth the 1 possible 'trade-off'.

The upper lip can go 'both ways'. For example if someone gets a LARGE maxillary advancement, the philtral upper lip area can kind of get 'squeezed on' and could look thinner or it could get pushed out too much along an unfavorable native orientation of the ANS-PNS plane (maxillary plane) and start looking conVEX. The other way is that since the upper lip is being brought more forward in the FORGROUND of the picture plane (or the mirror), the upper lip can look more prominent. But to the best of my knowledge, we are talking about a MODEST maxillary advancement that doesn't come with the same boat load of worries that some LARGE ones can come with. So, you would need to ask your surgeon as to any 'need' for V-Y sutures.

Here, I am just going with the flow of your DESIRE to have the maxillary advancement as part of the double jaw surgery and I can buttress some of the reasons behind your desire to have the maxillary advancement. But now you have all these concerns/worries about having that?

Again, I can tell you how things work and you can apply the concepts to weigh the pay offs vs. the trade-offs. I think there are more pay-offs than trade-offs (gains vs. losses) with the maxilla included in the surgery. Best I can do is what I have done via explaining why I think that is so. But I'm not going to 'sell you on' getting the maxillary aspect of the surgery, the very surgery you WANTED to have, gave reason to have which were reasonable to want soon after I validate some of the reasons to have it and then you express a lot of concerns about the very thing you wanted to have.

If you are looking for CERTAINTY, then certainly there is no chance of ANY unfavorable nose changes, no chance of ANY unfavorable changes to tooth/gum show, philtral changes etc. with NO surgery to the maxilla. But then again there's no chance of any favorable changes either with no surgery to the maxilla.

• Won’t the CCW change my teeth show too much? According to most surgeons, my teeth show is perfect now (although I would never want any more teeth show — personally, I think I’m flirting with a gummy smile at times).
• Will the upper lip look thinner and the philtrum longer? Or can this mostly be mitigated through a V-Y suture? Would you assume this V-Y suture is necessary?
• The nose concerns of GJ are legit, but according to the plan, the maxilla will only be advanced 3 mm. They could also use an alar cinch? I need the septum fixed too, so this will be done at the same time. Also, my nose is quite large in profile, but not that wide — look at the current alar base.

I think you would be OK with the double jaw surgery. Although the upper jaw looks RELATIVELY more advanced than the lower jaw, the upper jaw might not be 'over advanced' in its own right. A bit more advancement would tend to give more support to the base of the nose and give a straighter nose (dorsal) profile and with less downward tip rotation. Also, to get a good advancement to the lower jaw via CCW, they have to cut into the maxilla to affect a rotation. So, it's not as if cutting into the maxilla to provide a CCW-r and with a small amount of advancement is going to risk a bad base of the nose. I mean, a lower jaw advancement can be effected with just the CCW-r and no maxilla advancement. But again, to get a good lower jaw advancement via CCW-r, one does need a Lefort 1 cut to the maxilla to initiate the rotation even if there is no maxillary advancement. From those photos (front), I don't think the prospect of the gonial angles flaring out is going to be any aesthetic detriment either given that you have wide prominent cheek bones.

Basically, I don't see this as an AESTHETIC 'risk' for you to get the double jaw surgery. Looks more to me in the venue of an aesthetic 'pay-off' if you get a little upper jaw advancement and of course the CCW-r for which the maxilla needs to be cut into whether or not you get any advancement. No aesthetic risk either for getting more outward flare to gonial angles. Might even be possible to get a good advancement of the chin point with the BSSO because it can be taken out further with the CCW-r, in which case, you might not need a chin cut for a genio.

Feel free to cross reference what I told you here with the doctor/s who WANT to provide the double jaw surgery given you don't want the guy who just wants to do ONLY the lower jaw.