How much will nose upturn from 4-5mm upper jaw impaction?

[thisisonehand]

Hiya

I don't have a surgeon yet so I'm asking this here.
I'm getting rhinoplasty before jaw surgery. I think I need upper jaw moved up around 4-5mm, some advancement of lower jaw and genioplasty.

What I was wondering is this:
How will this affect my nose? I've heard if you ask for an alar stitch, the nose only widens 3% so the only thing left is upturning of the nose. How much upturning would you expect from around 4-5mm of impaction?

(On another note, I only worked out that I need the upper jaw moved up by 4-5mm myself, by seeing that 4-5mm of gum was present when I smiled, so I'm not sure if that's how much I need as they say it actually affects your face by 50% the amount of mms that they move it by- so I would actually need 8-10mm?! That seems a lot though)

Thanks, any help is much appreciated

[PloskoPlus]

Hiya

I don't have a surgeon yet so I'm asking this here.
I'm getting rhinoplasty before jaw surgery. I think I need upper jaw moved up around 4-5mm, some advancement of lower jaw and genioplasty.

What I was wondering is this:
How will this affect my nose? I've heard if you ask for an alar stitch, the nose only widens 3% so the only thing left is upturning of the nose. How much upturning would you expect from around 4-5mm of impaction?

(On another note, I only worked out that I need the upper jaw moved up by 4-5mm myself, by seeing that 4-5mm of gum was present when I smiled, so I'm not sure if that's how much I need as they say it actually affects your face by 50% the amount of mms that they move it by- so I would actually need 8-10mm?! That seems a lot though)

Thanks, any help is much appreciated

Do the rhino after the jaw surgery if possible.  Otherwise, you may have to do it all over again.

[thisisonehand]

Do the rhino after the jaw surgery if possible.  Otherwise, you may have to do it all over again.

Thanks for your reply PloskoPlus. The thing is, my nose is so big now and will be so much smaller after the surgery that I think it's worth doing it now, as any changes after jaw surgery I've seen so far are quite minor. I'd rather have it upturn a little or get a little wider than have to wait another few years..does that make sense?

[Cmonster]

With that much impaction your nose will change, upturn and possibly flare, I'd really recommend not touching your nose till after your are done with jaw surgery just to make sure there isnt another variable in the equation! Speak to your surgeon but from first hand experience with impaction-- change happens!

[thisisonehand]

Sorry, forgot to mention I realise it should not be 4-5mm impaction it should be around 2-2.5mm movement of upper jaw if I have 4-5mm gum show when smiling, right? And that's only if I want no gum show at all, which would make me look old as my lip moves 9-10mm from a full smile to rest, and my teeth are 10mm long, so however much gum show I have, I guess that is the amount of tooth show I will have at rest...(Which is an issue for another post!)

So if I have around 1.5-2mm of upper jaw impaction, by how much does the nose upturn?

[thisisonehand]

With that much impaction your nose will change, upturn and possibly flare, I'd really recommend not touching your nose till after your are done with jaw surgery just to make sure there isnt another variable in the equation! Speak to your surgeon but from first hand experience with impaction-- change happens!

Thanks for your reply. How much impaction of the upper jaw did you have? Did they move it only up as I think I need, or did they also rotate? And what were the changes in your nose? Thanks so much, because from all photos I've seen the nose doesn't change too much..

[nrelax11]

Im having an impaction as part of my surgery in june. I also have around 5mm gum show when I smile. Hes going to be impacting probably 2mm, plus the incision is 1mm, so 3mm total. He might be doing a little more than 2mm, but I dont know.

[Alue]

I haven't gone through surgery yet, but yea, if you are set on doing a nose job, wait till after jaw surgery.  Lets say you have a really good outcome with the nose surgery, then get jaw surgery and it changes everything, and your nose still looks off afterwards.  Better to do it once than twice. 

[sean89]

Just repeating what everyone else has already said. Don't have a rhino until after your jaw surgery. The 3% statistic you posted sounds to me very questionable. Every surgeon I've spoken to has told me that an impaction is going to cause nasal changes, before I even asked about the contraindications.

Use fillers in the meantime if your nose bothers you.

[thisisonehand]

Just repeating what everyone else has already said. Don't have a rhino until after your jaw surgery. The 3% statistic you posted sounds to me very questionable. Every surgeon I've spoken to has told me that an impaction is going to cause nasal changes, before I even asked about the contraindications.

Use fillers in the meantime if your nose bothers you.

I meant on average it will widen by 3% with an alar stitch, 11% without. This is from Peterson's Principles of Oral and Maxillofacial Surgery. From the chapter "Soft Tissue Changes Associated with Orthognathic Surgery".

They found that the alar bases widened in all patients and widening was lessened when
the alar cinch suture was used. The alar base widened an average of 2.9% with the alar cinch suture and 10.8% without it.41

41. Guymon M, Crosby D, Wolford LM. The alar base cinch suture to control nasal width in
maxillary osteotomies. Int J Adult Orthodon Orthognath Surg 1988;3:89?95

[thisisonehand]

Thanks for all your replies! The reason I'm doing it before jaw surgery is because:

1. After jaw surgery, the projection/length of my nose is not going to change from the profile, only the width and the amount that my nose is upturned will change. Thus, if I have rhino considering this fact, it is likely my nose will look ok after the jaw surgery as my nose is not wide at all or too upturned. I will ensure the surgeon doesn't show too much nostril from the front to avoid a pig-like nose after jaw surgery (although I think an upturned nose is cute), and I can even ask him to make it narrower.
2. Furthermore, I've seen quite a few, around 5-6, photos of similar surgeries to mine, or even more impaction, and I wouldn't have changed any of the 'after' noses I've seen so far. I thought they were fine.

eg
http://2.bp.blogspot.com/-2n5yEAiTN04/TXpUS-RmkLI/AAAAAAAAA4E/iK7b1XtcdhY/s1600/before%2Bduring%2Bafter%2Bfront%2Bno%2Bsmile.jpg
http://1.bp.blogspot.com/-Sj5vq4Vi72U/TXpOwsMazGI/AAAAAAAAA3c/JM_wheMcbRM/s1600/Before%2BDuring%2BAfter%2BFront%2BSmile.jpg
This girl already had an upturned nose, and had 5mm impaction and hers turned out fine. As I said I haven't seen one bad case.

3. A further point is that I've heard there is not only an alar stitch to make sure width doesn't increase too much, but also another stitch to make sure the nose doesn't upturn too much.
4. Since I have 5mm of gum show, there will be around 2-3mm maximum impaction, and this most likely won't dramatically change my nose.
5. I want to look nice for the start of university
6. I live in the UK and it takes so long to find a good jaw surgeon, and if I go on the NHS it will take so long. I just don't want to wait another 2-3 years.

So altogether, I will either want minor rhino after jaw surgery, or more likely for me as I'm not looking for a perfect nose, none at all.
Also, even a slightly deviated septum doesn't bother me too much if it comes to that and as I said if I really don't like it I can do a slight revision.

Phew sorry for the long post, I've just thought this through and still want to go through with rhino before jaw surgery.

[thisisonehand]

Im having an impaction as part of my surgery in june. I also have around 5mm gum show when I smile. Hes going to be impacting probably 2mm, plus the incision is 1mm, so 3mm total. He might be doing a little more than 2mm, but I dont know.

Hi nrelax,

Thanks so much for your reply, your case is similar to mine then.. Are you sure it's not just 2mm? I've never heard of the incision being part of the impaction? And 3mm would mean it would be a 6mm change to your face (if this 50% thing I heard is right), which would take away one more mm than intended for the gumminess you have..
Does anyone else have any info on this?

Also, did your surgeon say by how much your nose will be likely to widen/upturn? Would be valuable to get your opinion on this as your case is so similar to mine.

[nrelax11]

Im not quit sure on the measurements of the impaction. I mean at my consultation with him, he said he'd only do a couple mm's because he knows as we age our lips droops lower. Im not going go be seeing him probably till late april early may since its getting close to my surgery. Also why does a 3mm impaction cause a total of 6mm change to the face? Is it just because of the impaction and then the auto-rotation?  In the end I'll probably have some different nose changes because my maxilla and mandible are going to be advanced too.  Also, what my surgeon and someone told me on her is that they can also shave down your anterior nasal spine to help with the nasal tip from upturning. Thats the one thing im worried about.