Red head on Arnett's website

[streo]

The flash movie that plays on http://www.arnettcourses.com shows a read head (6th slide, 3rd patient) with a retruded mandible.  My question is what do you think her surgery plan consisted of?  To me it seems that she only had lower jaw surgery as her upper lip/nose angle seems almost exactly the same between her before/after profile.

[streo]

upper jaw surgery for sure.

How do you know?  Her profile pic shows almost exactly the same angle between nose and upper lip.  Actually you can take her before profile and superimpose it directly onto the after and they are identical.

CORRECTION: I did a superimposition in Photoshop and her nose between before and after indicates a CW rotation!  I'll try and put together a gif that illustrates this, but when I fade the layer between before and after the nose/lip rotates in the CW direction.

UPDATE: This was the best alignment I could do given the photos posted for her profile:

http://gickr.com/results3/anim_d55bd97e-9e67-2854-3929-f612671ff8c1.gif


The mole on her cheek and the nose piercing was what I used to align it, and it seems like an obvious CW rotation, but her head might not have been exactly aligned between the two pictures, which could account for the rotation.

I was able to get a better before/after animation because it seems that her head is ever so slightly tipped forward in the after picture (I had to rotate the before shot CW just a tiny bit):

http://picasion.com/pic58/67db7e11ef2374606be6566c2ac7f109.gif

It almost looks like she might have had her lower jaw moved forward + genioplasty and maybe cheekbone augmentation.  I doubt she had her upper jaw touched at all, but your guess is as good as mine!

[Heavyweight]

Her upper jaw was definitely moved forward. It's hard to tell what sort of rotation she had because she had a lot of fat under her neck before surgery. She might have had CCW rotation with fat removal, which could give the illusion of CW rotation. It seems that A/G give almost all class 2 patients a degree of CCW rotation.

[streo]

What do you gather from the second pic.  It really looks to me that only her lower jaw was moved forward.  The upper jaw portions seem to me to be only a difference of the soft-tissue changes, and nothing more.  The mole on her cheek and her nose piercing were my guides for aligning her before/after.  These two points seem to be fairly consistent.  If her upper jaw were moved then I think these two points would have moved because of changes to the mid-face, but this clearly is not the case.

http://picasion.com/pic58/67db7e11ef2374606be6566c2ac7f109.gif

EDIT: furthermore, she doesn't have a mid-face deficiency.  I would be surprised if AG would move the upper jaw only for cosmetic purposes.

[Heavyweight]

This picture should make it pretty clear that her upper jaw was moved forward. The area around her nose and below her cheekbones projects more in the after shot, and the base of her nose has much more support. I don't think A/G would operate on just one jaw. That would go against their philosophy.

[streo]

This picture should make it pretty clear that her upper jaw was moved forward. The area around her nose and below her cheekbones projects more in the after shot, and the base of her nose has much more support. I don't think A/G would operate on just one jaw. That would go against their philosophy.

Have you accounted for soft tissue changes associated with lower jaw advancement?  This is known to happen.

[Heavyweight]

Have you accounted for soft tissue changes associated with lower jaw advancement?  This is known to happen.

Her nose wouldn't have changed so much with just lower jaw surgery. Are you having second thoughts about not getting bimax? I don't blame you. The first surgeon I consulted with recommended lower jaw advancement only, and I knew that was a bad idea, so I met with another surgeon who said that my upper jaw is severely recessed too.

[streo]

Her nose wouldn't have changed so much with just lower jaw surgery. Are you having second thoughts about not getting bimax? I don't blame you. The first surgeon I consulted with recommended lower jaw advancement only, and I knew that was a bad idea, so I met with another surgeon who said that my upper jaw is severely recessed too.

Again, sometimes just moving the lower jaw changes the perception of the nose because it is now in proportion to a normally proportioned jaw/chin.  

As for second thoughts, those don't enter into the picture - I'm pretty convinced I don't need it because my midface is actually not retrusive or recessed.  The cephalometric measurements indicate that I'm pretty much spot on.

I'm trying to find more examples of lower jaw advancement only other than HTK on JSB.  There is that girl Suzie from Eastern Europe, but those are the only two cases I was able to find.  If this is what I think it is then that would make three.

As for "going against their philosophy" - if you believe that then I would seriously question if AG are merely using one tool for every single problem that comes their way.  That would seem irresponsible to me, so I wouldn't give that much credence.

EDIT: here's that girl Susie I was talking about.  Notice how her upper lip has changed from BSSO + genioplasty only.  If she didn't explicitly mention that she did not have upper jaw surgery (which she wished she had) then I would have assumed automatically she had an AG-style CCW rotation.

Before:
http://i56.tinypic.com/5ju0aq.jpg

After:
http://i54.tinypic.com/2gt9i4i.jpg

[streo]

the distance between her upper lip and nose clearly shortened, which indicates the upper jaw may have been elevated.

Is that what you see from the profile before/after pics as well?

[CK]

Is that what you see from the profile before/after pics as well?

no, just the front.

[streo]

Given that Susie had only lower + genio we can readily conclude that moving the lower jaw alone can in fact change the upper lip.  The profile gif with the before/after shows what seems to me identical nose/upper-lip proportions.  The best way I can explain the perception of nasal changes in the frontal view is that there is probably better support from the underlying soft tissue because it now has better support from the new bone structure itself.  There's also the possibility that the before/after of the frontal view isn't at the EXACT same angle between the two pictures giving a slightly different perception.

I'm very doubtful that the AG patient had her upper jaw moved at all.  I would still like to know for certain instead of merely speculating like this.

[CK]

I'm very doubtful that the AG patient had her upper jaw moved at all.  I would still like to know for certain instead of merely speculating like this.

im pretty sure she did. in upper jaw surgeries i believe bone is often harvested from the nasal floor, which can sometimes make it smaller and look different. i don't think the change is due to "perception."

[streo]

im pretty sure she did. in upper jaw surgeries i believe bone is often harvested from the nasal floor, which can sometimes make it smaller and look different. i don't think the change is due to "perception."

Now tell me honestly: if Susie never posted that she did NOT have upper jaw surgery what would you assume?

[streo]

cool. im not an orthognathic surgeon. just guessing.

Me too!!!

[Antbee]

I'm going to solve this tomorrow - I'm going into their office to look at before and afters. I'll ask.