Author Topic: How can I fix my face  (Read 8494 times)

kanko

  • Newbie
  • *
  • Posts: 22
  • Karma: 0
Re: How can I fix my face
« Reply #30 on: July 07, 2022, 05:13:00 AM »
Can't see your IMGUR plan because it's set up for people to sign in and I'm not an IMGUR member.
Any increase to the ANS projection will make an already prominent ANS more prominent.

Cant he avoid the nose changes by getting a subspinal lefort?

TheGerman

  • Newbie
  • *
  • Posts: 28
  • Karma: 1
Re: How can I fix my face
« Reply #31 on: July 07, 2022, 09:21:52 AM »
Can't see your IMGUR plan because it's set up for people to sign in and I'm not an IMGUR member.
Any increase to the ANS projection will make an already prominent ANS more prominent.
I tried to send you a private message I hope it worked. This forum is so weird to use. Let's try to find a way I can share the pictures with you.

kavan

  • Global Moderator
  • Hero Member
  • *****
  • Posts: 4029
  • Karma: 426
Re: How can I fix my face
« Reply #32 on: July 07, 2022, 02:08:29 PM »
I tried to send you a private message I hope it worked. This forum is so weird to use. Let's try to find a way I can share the pictures with you.

I SAW your IMGUR photos and some scans which were in your FIRST post and it looked like I SAID was the case. It's the PLAN the doctor gave which is on some IMGUR link that requires a sign in which I can't see.  HERE is the PLAN link you would need to make visible publicly: " Here is the plan he gave me":
https://imgur.com/a/wkq0B2c

The board lets you ATTACH photo files which you will see as 'Attachments and other options' where you can choose a file to upload on the board. (It's right below where you type in a post.) So, try clicking on that to upload your PLAN that can't be viewed on one of your IMGUR links. Otherwise I won't be able to see your PLAN; the PLAN the doctor gave. Your face photos and your scans are NOT 'plans' and AGAIN, I already gave advice based on those.
Please. No PMs for private advice. Board issues only.

TheGerman

  • Newbie
  • *
  • Posts: 28
  • Karma: 1
Re: How can I fix my face
« Reply #33 on: July 07, 2022, 03:07:06 PM »
I SAW your IMGUR photos and some scans which were in your FIRST post and it looked like I SAID was the case. It's the PLAN the doctor gave which is on some IMGUR link that requires a sign in which I can't see.  HERE is the PLAN link you would need to make visible publicly: " Here is the plan he gave me":
https://imgur.com/a/wkq0B2c

The board lets you ATTACH photo files which you will see as 'Attachments and other options' where you can choose a file to upload on the board. (It's right below where you type in a post.) So, try clicking on that to upload your PLAN that can't be viewed on one of your IMGUR links. Otherwise I won't be able to see your PLAN; the PLAN the doctor gave. Your face photos and your scans are NOT 'plans' and AGAIN, I already gave advice based on those.

I hope the link works now:
https://imgur.com/a/wroEXY7

kavan

  • Global Moderator
  • Hero Member
  • *****
  • Posts: 4029
  • Karma: 426
Re: How can I fix my face
« Reply #34 on: July 07, 2022, 03:17:24 PM »
I hope the link works now:
https://imgur.com/a/wroEXY7

Does NOT work for me. Still needs a sign in. Sorry, but too much time is being spent discussing NOT seeing the plan. You will need to just upload it on the board if you want me/others to look at it. See if SOMEONE ELSE can see it and copy it onto the board. Otherwise, I already gave you directions as to HOW to enter the plan publicly on the board OR try another photo image uploading site.
Please. No PMs for private advice. Board issues only.

TheGerman

  • Newbie
  • *
  • Posts: 28
  • Karma: 1
Re: How can I fix my face
« Reply #35 on: July 09, 2022, 02:09:32 AM »
Does NOT work for me. Still needs a sign in. Sorry, but too much time is being spent discussing NOT seeing the plan. You will need to just upload it on the board if you want me/others to look at it. See if SOMEONE ELSE can see it and copy it onto the board. Otherwise, I already gave you directions as to HOW to enter the plan publicly on the board OR try another photo image uploading site.
Google drive might work:
https://drive.google.com/drive/folders/1qtvd3HiqGy1SrXTFB1OqLycSNhU43aNn?usp=sharing

kavan

  • Global Moderator
  • Hero Member
  • *****
  • Posts: 4029
  • Karma: 426
Re: How can I fix my face
« Reply #36 on: July 09, 2022, 12:31:55 PM »
Google drive might work:
https://drive.google.com/drive/folders/1qtvd3HiqGy1SrXTFB1OqLycSNhU43aNn?usp=sharing

OK. I got to the new place you stored your files.

What I was looking for specifically was the PLAN READOUT which is a readout of all the areas displaced and the millimeter amounts. In particular I was looking for whether or not the ANS was to be moved FORWARD in addition to the rotation or with the rotation. It is because you conveyed that there would be forward advancement of the ANS:

......the Dr. I consulted with said he wouldn't do any advancement on the upper jaw, only rotation, which would result in an "advancement" of the ANS by about 2mm.....

There was NO actual directional displacement plan read out. But it looked like the rotation was a FAVORABLE one which corrected the relationship between the ANS and the upper lip as to REDUCE the overly obtuse nose base to upper lip angle. That is to say the CCW-r will improve the relationship between the ANS and the upper lip.

The advancement to the lower jaw (including the chin) is significant. The chin is advanced and also elongated via a CW rotation of the chin; a type of genio that elongates the chin in addition to advancing it.

The doctor has provided AMPLE VISUAL INFORMATION, for example a side by side look at the profile CONTOUR CHANGES for the profile and 3D type soft tissue model visuals for you to look at the changes to determine yourself whether you like those changes. In that regard, an actual directional displacement read out isn't really needed (by you) to visually compare the proposed changes in SELF DETERMINATION whether or not they are to your liking. They are AMPLE enough for you to do that. To my eye, they improve your profile contour and also the 3/4 view seen from the 3D type soft tissue model visuals.
Please. No PMs for private advice. Board issues only.

TheGerman

  • Newbie
  • *
  • Posts: 28
  • Karma: 1
Re: How can I fix my face
« Reply #37 on: July 10, 2022, 05:28:51 AM »
OK. I got to the new place you stored your files.

What I was looking for specifically was the PLAN READOUT which is a readout of all the areas displaced and the millimeter amounts. In particular I was looking for whether or not the ANS was to be moved FORWARD in addition to the rotation or with the rotation. It is because you conveyed that there would be forward advancement of the ANS:

There was NO actual directional displacement plan read out. But it looked like the rotation was a FAVORABLE one which corrected the relationship between the ANS and the upper lip as to REDUCE the overly obtuse nose base to upper lip angle. That is to say the CCW-r will improve the relationship between the ANS and the upper lip.

The advancement to the lower jaw (including the chin) is significant. The chin is advanced and also elongated via a CW rotation of the chin; a type of genio that elongates the chin in addition to advancing it.

The doctor has provided AMPLE VISUAL INFORMATION, for example a side by side look at the profile CONTOUR CHANGES for the profile and 3D type soft tissue model visuals for you to look at the changes to determine yourself whether you like those changes. In that regard, an actual directional displacement read out isn't really needed (by you) to visually compare the proposed changes in SELF DETERMINATION whether or not they are to your liking. They are AMPLE enough for you to do that. To my eye, they improve your profile contour and also the 3/4 view seen from the 3D type soft tissue model visuals.

I see. Regarding the ANS movement stuff, the Dr. explained to me that his plan is to only rotate the maxilla by 7 degrees ccw. But he said that this rotation would result in a small advancement of 2mm for the ANS. Meaning the ANS isn't the exact rotation point..

Should I ask the Dr. for the exact movement table? I remember him showing it but he didnt share it with me. I feel like visuals go over numbers in this case, like you already mentioned.

The rough movements I managed to memorize were: Maxilla 7 degrees ccwr resulting in 2mm advancement of the ANS, BSSO 8mm, genioplasty 6mm, ramus widening 4mm on one side and 5mm on the other.

Two more questions:
-Do you think I would benefit from ramus widening? Straighter ramus viewed from the front and slightly increased gonial width? Or would it make my jaw too wide
-What do you think of my occlusion in the post OP pics. This plan is a surgery first/only approach since the Dr. said my occlusion is fine/stable and he wants to keep it. But I don't want to cut corners

kavan

  • Global Moderator
  • Hero Member
  • *****
  • Posts: 4029
  • Karma: 426
Re: How can I fix my face
« Reply #38 on: July 10, 2022, 11:40:34 AM »
I see. Regarding the ANS movement stuff, the Dr. explained to me that his plan is to only rotate the maxilla by 7 degrees ccw. But he said that this rotation would result in a small advancement of 2mm for the ANS. Meaning the ANS isn't the exact rotation point..

Should I ask the Dr. for the exact movement table? I remember him showing it but he didnt share it with me. I feel like visuals go over numbers in this case, like you already mentioned.

The rough movements I managed to memorize were: Maxilla 7 degrees ccwr resulting in 2mm advancement of the ANS, BSSO 8mm, genioplasty 6mm, ramus widening 4mm on one side and 5mm on the other.

Two more questions:
-Do you think I would benefit from ramus widening? Straighter ramus viewed from the front and slightly increased gonial width? Or would it make my jaw too wide
-What do you think of my occlusion in the post OP pics. This plan is a surgery first/only approach since the Dr. said my occlusion is fine/stable and he wants to keep it. But I don't want to cut corners

That's the part that I found confusing when I looked at the ceph and started using geometrical observation to determine the rotation point. The ANS looked to be in the same place which is consistent with it being rotation point. Now on the (before) ceph, there was a RED DOT which was at or near a point called the 'A' point which is kind of behind the upper lip and below the ANS point. Now with CCW-r around the ANS point, the 'A' point (behind the soft tissue of lip) would go forward.

Both the ANS point and the A point are landmarks to the anterior maxilla which one sees on a ceph in profile view. The A point is displaced with CCW-r around the ANS point and the displacement of the A point (where the rotation is around the ANS point) can move the soft tissue of the upper lip forward.

Given that the overly OBTUSE angle formed by base of nose and upper lip was REDUCED by the rotation, (and that DID look GOOD), my GUESS is that he may have told you that part of the maxilla BELOW the ANS would move 2mm forward and something got lost in the translation.

The have advanced computer simulation programs that allow them to try different rotations and displacements as to get a prediction of the soft tissue response, bite, profile improvement etc. So, my guess is CCW-r around the A point kicked up a good profile contour.

None the less, the SALIENT thing is that it's an improvement.

Again, my MAIN aesthetic focus/concern here was with the ANS being unfavorably displaced with maxilla advancement. But the ceph (after) has ANS in same place but soft tissue of lips go forward to CLOSE IN on the OVERLY OBTUSE nose to lip angle and THAT makes you look better to the part I had aesthetic concerns over. So, that is SOLVED and not something you need to worry about.

Now the other things like ramus widening (increased gonial width) need to be things you SELF DETERMINE via the VISUALS he provided. The overall change looks GOOD to my eye and good occlusion is worked into the whole thing. But again, it's YOUR EYE that needs to like the proposed changes.

The exact displacement read-out is not needed at this point.
Please. No PMs for private advice. Board issues only.

TheGerman

  • Newbie
  • *
  • Posts: 28
  • Karma: 1
Re: How can I fix my face
« Reply #39 on: July 14, 2022, 07:41:53 AM »
That's the part that I found confusing when I looked at the ceph and started using geometrical observation to determine the rotation point. The ANS looked to be in the same place which is consistent with it being rotation point. Now on the (before) ceph, there was a RED DOT which was at or near a point called the 'A' point which is kind of behind the upper lip and below the ANS point. Now with CCW-r around the ANS point, the 'A' point (behind the soft tissue of lip) would go forward.

Both the ANS point and the A point are landmarks to the anterior maxilla which one sees on a ceph in profile view. The A point is displaced with CCW-r around the ANS point and the displacement of the A point (where the rotation is around the ANS point) can move the soft tissue of the upper lip forward.

Given that the overly OBTUSE angle formed by base of nose and upper lip was REDUCED by the rotation, (and that DID look GOOD), my GUESS is that he may have told you that part of the maxilla BELOW the ANS would move 2mm forward and something got lost in the translation.

The have advanced computer simulation programs that allow them to try different rotations and displacements as to get a prediction of the soft tissue response, bite, profile improvement etc. So, my guess is CCW-r around the A point kicked up a good profile contour.

None the less, the SALIENT thing is that it's an improvement.

Again, my MAIN aesthetic focus/concern here was with the ANS being unfavorably displaced with maxilla advancement. But the ceph (after) has ANS in same place but soft tissue of lips go forward to CLOSE IN on the OVERLY OBTUSE nose to lip angle and THAT makes you look better to the part I had aesthetic concerns over. So, that is SOLVED and not something you need to worry about.

Now the other things like ramus widening (increased gonial width) need to be things you SELF DETERMINE via the VISUALS he provided. The overall change looks GOOD to my eye and good occlusion is worked into the whole thing. But again, it's YOUR EYE that needs to like the proposed changes.

The exact displacement read-out is not needed at this point.

I see. Very reasuring that a knowledgable user agrees on the plan. And yea in the end it's not about exact measurements but about what looks good. I was asking about the occlusion because one surgeon (the one who also made the plan I showed) said I can/should do surgery first. However, another surgeon said that I need decompensation orthodontics before. Two world class surgeons contradicting each other really confused me..

Regarding ramus widening, I might try jaw fillers first to try if the general direction is the right one. Very hard to judge what impact an increased bigonial width would have on my face sadly.

By the way, would you say I might need MSE? Can provide pictures of my bite if necessary.

kavan

  • Global Moderator
  • Hero Member
  • *****
  • Posts: 4029
  • Karma: 426
Re: How can I fix my face
« Reply #40 on: July 14, 2022, 12:44:13 PM »
I see. Very reasuring that a knowledgable user agrees on the plan. And yea in the end it's not about exact measurements but about what looks good. I was asking about the occlusion because one surgeon (the one who also made the plan I showed) said I can/should do surgery first. However, another surgeon said that I need decompensation orthodontics before. Two world class surgeons contradicting each other really confused me..

Regarding ramus widening, I might try jaw fillers first to try if the general direction is the right one. Very hard to judge what impact an increased bigonial width would have on my face sadly.

By the way, would you say I might need MSE? Can provide pictures of my bite if necessary.

Can't make a call on that. As for surgery first vs decompensation, you've gotta go with the PLAN if you like the PLAN. So, if the PLAN I looked at is also to your liking, you go with the way the doctor wants to conduct the ORTHO with it.
Please. No PMs for private advice. Board issues only.

LeFort 3000

  • Jr. Member
  • **
  • Posts: 83
  • Karma: 5
Re: How can I fix my face
« Reply #41 on: August 01, 2022, 06:10:56 PM »
in general, how about just cutting/shaving the ANS during LeFort? I mean it seems to be a very obvious and simple solution without having to do a additional rhino, no? just shave off 2,3,4mm, seems simple enough

TheGerman

  • Newbie
  • *
  • Posts: 28
  • Karma: 1
Re: How can I fix my face
« Reply #42 on: September 19, 2022, 07:29:57 AM »
in general, how about just cutting/shaving the ANS during LeFort? I mean it seems to be a very obvious and simple solution without having to do a additional rhino, no? just shave off 2,3,4mm, seems simple enough
Sadly I've never seen any results of that procedure which makes it rather risky for me.