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I understand the wish not to touch the maxilla if it is not needed to get a perfect bite. However, anatomically speaking my maxilla is recessed. He admit this too. Others surgeons told me too. Aesthetically speaking, I have somewhat of a flat maxilla with a concave look to it and a visually disproportionally large nose. So it's not only the simulation: I honestly feel like I will never really like my results if only the mandible is moved forward. My upper lip and nose need more support too.

The main issue with moving the maxilla and thus the mandible a few extra millimeters forward is apparently the fact that my gonials would flare outwards. Is this really a big issue? Let's say they move the maxilla forwards 4 millimeters and the mandible 4 millimeters extra, suddenly the gonial angles are a big issue which they wouldn't be if they didn't go for the 4 extra millimeters?

I am really having difficulties with the idea that after all this pain and suffering my maxilla would still be, knowingly, recessed.

I think a surgeon could go either way due to the space you have to move the teeth themselves forward. Gunson would probably do both jaws, for example. Maybe put surgery on hold and get some more consults.

How great of a risk is there for something like that?

With a skilled surgeon who has done it a lot, it's low, and visa versa.

Hi everyone,

My surgery is supposed to be on Monday. But I’m totally panicking once I saw the simulation.

I always presumed (and was told) I would get bimax, however my surgeon told me today that he would only do BSSO (and potentially a genio). First pic is before, second with BSSO and third with genio as well: simulation.

Some more pictures of my face and CBCT, although these were taken before the premolar extractions and orthodontics.

However, I don’t like this current simulation at all. This looks like a flat face and I feel like I need upper jaw advancement as well? My surgeon told me it’s not necessary or needed in my case and that the lower jaw advancement would be too big if we move the upper jaw too (with the gonials flaring out too much in that case?). I don’t even think I have gonial angles that flare out that much now? A smaller advancement, e.g. 3 mm, wouldn’t be worth it in his opinion. But I immediately see, in the simulation and daily in the mirror, the lack of upper jaw support for my nose. Multiple surgeons pointed it out.. I think even a few mm could make an aesthetic difference.

 I’d highly prefer something like this with additional upper jaw advancement: modified simulation.

Now what?

Thanks for the response. Out of interest, why would you be cautious with chin movement in my case? I think we can both agree my chin is short (comes with my gonial angle)

I'm not sure on that, but it looks pretty normal to me. I'd probably stay 5mm range, but a few consults with 3 really good surgeons should clarify the exact movements.

I don't think you need jaw surgery. If you want more length just CW rotate the chin (maybe)...still I'd do that with caution.