My surgical plan calls for 6-7mm of maxillary advancement (MMA+CCW). Some questions:
- That's 4mm to the nasal base. Is that going to be an unaesthetic amount of widening? I'm a guy and I have a narrow nose already at least. I'm thinking not right now.
- My upper lip is relatively thick and my upper lip is neutral to my nose right now. I noticed one surgical plan shows the upper lip as 3mm shorter afterwards so like 12mm instead of 15mm I think (numbers could be off). I think it was a VY-plasty. My philtrum is on the longer side as well. Is that a typical side effect of shortening the upper lip? Is this a tool surgeons use to manage protrusion sometimes?
- How much protrusion can be tolerated on a white guy without acquiring a simian look? My plan calls for a net of 4mm, after the lip work. I read a thesis suggesting than -3mm to 3mm was tolerated by laymen and 6mm was definitely on the unaesthetic side.
- One surgeon mentioned bicuspid removal as an option. How much can the orthodontist likely regain doing this? Can my wisdom teeth be removed instead? I suppose it's an acceptable sacrifice.
- Am I making too much out of this? 7mm seems to be about half the distance between my upper lip and tip of my nose right now.
I could ask to reduce advancement, at the cost of reduced odds of success in cure. 12mm PAS is considered normal and adequate. I'm 7-8mm now so I could probably afford to subtract 2mm of advancement to have a 5mm advancement and end up at 12-13mm, which to be fair is where most OSA patients end up after their MMAs. Combined with bicuspid removal and maybe lip work I'm hoping there's a workable solution here.
