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I think something got lost in the translation as to what was said vs. what was meant. The flaring associated with maxillary advancement refers to the flaring of the alar rims at base of nose. The angle increases associated with maxillary advancement of the base of the nose refers to the increase in the nose to lip angle which could become overly obtuse (more than 90 deg angle).

Hi kavan, thanks for your response.

I don't actually know whether I have a prominent anterior nasal spine. No surgeon ever mentioned this. They did however mention the fact that my maxilla is somewhat recessed, even the surgeon who made the simulation from this post. So, even if the ANS is prominent and I would need a seperate rhinoplasty to remedy this, I would still like the advancement of the maxilla because of the concave look my middle facial third now has.

Also, in response to another post of mine last year, you said the following:

If you see this unedited picture - where I jutted my mandible forward - I believe it to be quite obvious that I have a flat and recessed maxilla. Again, all surgeons mentioned this. It also would be the conclusion of this scan and the conclusion of my CBCT Dental, which sounded like this:

"Examination: CBCT DENTAL
Cone Beam CT of the paranasal sinuses
Examination without contrast with axial slices.
No sinusitis.

Cone Beam CT of the maxillofacial complex
The occlusion at the molar level appears normal.
SNA = 79 degrees
SNB = 75.3 degrees
ANB = 3.7 degrees"

If I'm not wrong these degrees would point out that the maxilla is somewhat recessed and the mandible is more severely recessed.

The main thing I'm struggling with is the reasoning why my surgeon discouraged me to go for the maxilla advancement: if the maxilla is advanced, the mandible should be advanced even more. He warned for flaring gonial angles. I'm hoping to get a second opinion about this, even more so if we would only advance the maxilla, let's say 3 or 4 mm. Will this 3 or 4 extra mm of (corresponding) mandible movement really create flaring gonial angles? That's what I would like to figure out. And whether there is a way to compensate for this, e.g. bone shaving, etc.

Thanks in advance for your, much appreciated, insights.

Would dental "decompensation" still be needed if one does a fully CUSTOM jaw surgery?

Firstly, I can't see your photos. Very OLD computer and I don't use a Google account. Secondly, I don't need to in order to give you some information about your concerns.

1: When people say you look 'different', it is neither a compliment nor an insult arising from a sense of envy/ jealousy. It conveys there is something 'off' with the changes. So, it is NEITHER a 'you look great what did you do?' NOR an assessment on their part that you look worse. It's a neutral statement where they don't know what to think of the changes in EITHER positive OR negative terms. 'Different' means that something is 'off' that the onlooker CAN'T assess as 'good' or 'bad'.

2: It is NOT uncommon for some doctors to OVER-COMPENSATE with a LARGE genio when a person is a candidate for lower jaw advancement and/or double jaw surgery. On the FLIP SIDE, max-fax doctors who DON'T do that, will bring out the chin POINT with the lower jaw advancement (which often is a part of DOUBLE JAW surgery where the maxilla is either advanced and/or rotated) such that any added genio will be minor.

3: As for an APNEA test for the DJS, it 'depends' whether or not the surgery is SELF PAY or IF insurance is paying for it. The type of doctors I mentioned on statement #2 are often SELF PAY and the surgery is not dependent on whether or not you have apnea. That is to say, IF it's one where counter clockwise rotation would allow them to minimize the maxilla advancement AND maximize the lower jaw advancement (and add a modest genio if that's also needed), that type of surgery would address both aesthetics AND apnea whether you had it or not OR if it looked like you could have it in the future. Like NO apnea test is needed to predict that a lower jaw advancement would OPEN the AIRWAY and help breathing with a self pay doctor who optimizes airway, bite and aesthetics.   

4: In RETROSPECT, if you were actually a candidate for DJS (and again, I can't see your photos, don't need to but it SOUNDS like you WERE a candidate for it), you COULD pursue that. Most likely they would have to REVERSE the prior genio which is not difficult to do because it's a cut right through the prior one to set it backwards given the lower jaw advancement would bring the chin point forwards. The PREPARATION or 'work up' for DJS is a lot of time in BRACES to DE-COMPENSATE the bite (to de-compensate for prior camouflage ortho). So, AGAIN, for all of that, it (most likely) DEPENDS on whether your pursuit is for a SELF PAY max-fax. An insurance one in US or something like NHS like they have in Canada or England, will just do the minimum to help with the breathing. But AESTHETIC optimization is not part of the 'financial equation' when the government or insurance is paying for it.

Conclusion: Based on what you have expressed here and also that you have expressed your situation well, it DOES sound that they over compensated with the chin and did so to MASK the lower jaw recession and that type of masking made your maxilla (mid face area) looked relatively more recessed by relative comparison. So, your pursuit for optimizing aesthetics, bite and airway would be in venue of SELF PAY doctor more than it would be government or insurance pay doctor. Also, I DON'T deny that you could look better (as GJ says you do) given that OVER COMPENSATION with a genio to MASK lower jaw recession is going to be somewhat of an 'improvement'. However,in terms of people who are actually candidates for the DJS where optimizing the balance of bite, airway and aesthetics IS part of what some self pay doctors do, I think what you say here is WITHIN REASON of that type of pursuit. This will require consultations and perhaps outside of what ever country. Hence, if that is within your capacity to pursue, I would say your concerns fit into such a pursuit.