Author Topic: Analyze My Cephalometric X-ray  (Read 10006 times)

Tezcatli

  • Jr. Member
  • **
  • Posts: 83
  • Karma: 5
Re: Analyze My Cephalometric X-ray
« Reply #15 on: March 02, 2016, 10:01:28 PM »
I realize most feel I'm not a candidate aesthetically but I want you guys to look again at my morph and tell me if you still feel the same.

I did a morph predicting STRAIGHT MMA without genioplasty.  I first slightly CCW rotated the lower half of my nose to the bottom of my upper lip since that soft tissue should rotate CCW even with straight advancement since above the advancement will naturally rotate.  This includes desireable upper lip projection and undesireable nose upturn.  Then I advanced from the top of the lower lip on down straight horizontally.  Finally, I pulled the lower lip in a bit since I think it won't curl out so much after mandibular advancement.

This is the result.  I roughly measured 10mm advancement at the chin by sizing my cephalometric x-ray to my profile shot and using the ruler on the ceph machine to compare the space between before and after.  I've also posted the photo I used to do this.  I realize it's probably not exactly 10mm, but I think it's close, say within 1mm either way.

I'd also hope that my jawline would pop slightly more with the advancement due to tightening skin, but I didn't try to create that effect.

Further questions:
1) Is this achievable/realistic?  Did I underestimate the amount the top of my philtrum will advance (i.e. under-project "chimp lip")?
2) If it is achievable, how does my morph look?  Do you think it looks better than my current profile?
3) Is 10mm bimax considered a large advancement?  How much could I expect this much advancement to affect my airway?

If you guys think I'm crazy, well, let me know that too I guess.

Hi, from my knowledge soft tissue cannot be predicted with too much certainty, it's unfortunate but no morph is perfect because of that. The surgeon can put your bones in the position he wants down to 0.1 of a mm, but he cannot predict the soft tissue to such a degree. However some things are to be expected, your nose should widen but not upturn so much, I've seen hundreds of before and afters and no nose has upturned that much, most of the time the tip stays in the same place after swelling goes down, but the alar almost always flares and lifts a little bit. That's also somewhat bad but in my case my nose is pretty narrow so it's not a big problem.
My nose IS naturally upturned(genetics, my mother and dad are the same) and it scares me a bit that it may become piggy but my surgeon said he can control it and in fact his patients looked fine after it. Worst case scenario I get a derotation rhinoplasty as an upturned nose is terrible for a guy.

Your morph looks better, except the nose, but I think surgery would be even better because your jaw would pop out more and the upper lip would probably be a little more forward than the lower one. I think it's not properly rotated. Moreover the cheeks seem to pop out more after a lefort I advancement because some of the muscles in the cheek are attached to the lower maxilla.
Look at this cherrypicked example(the girl is gorgeous):
http://imgur.com/a/mUclH

Alar flare, but her already upturned nose stays the same, no piggy nose.
See how her cheeks are more prominent now, the line is almost near the mouth when she smiles.

10mm is a large advancement but you also need to consider the original size of your bones, only the surgeon can really determine it.


About craziness...jaw surgery evolved a lot in the last decades, it's very likely since your bite is fine that you will not need to stay in braces for years and most likely you will only need rubber bands, not wire shutting your mouth and eating through a straw for months. Advancing both jaws is also much less likely to relapse than setting back the lower jaw.
Having said that, it's still a pain in the ass but after a few years you will not even remember it.


Now, you cannot become too fixated on that, you're a normal looking person to begin with, it's not like you have a major deformity, if you think your face right now is creating you tons of problems it's most likely in your head. Somebody with Crouzon or a severe under or overbite can suffer discrimination, people staring, and so on, it's not your case, your face blends in the general population.

I also realized you may have a slight negative orbital vector, it may get somewhat better after surgery or you could look into infraorbital implants or a lefort 3(but no doctor will do it in your case). That will also give your face a sunken look if that's what you want to fix.

kjohnt

  • Sr. Member
  • ****
  • Posts: 387
  • Karma: 26
Re: Analyze My Cephalometric X-ray
« Reply #16 on: March 02, 2016, 11:58:10 PM »
I wonder if that girl simply had additional bone growth to account for some of the facial changes.  Her face just appears wider.

I'm not overly worried about my nose too much TBH, a small upturn wouldn't be horrible and it's already narrow, though if it didn't change much that would be cool since I feel it's good as is.

I'm still wondering if a sliding genioplasty in conjunction with bimax would be the way to go, e.g. maybe 6mm bimax and 3mm genio or something.  I just don't want a deep labiomental fold.

It's weird about the orbital vector and even my cheeks... I feel they look a little worse in that photo than they do in other pictures.  Maybe because there are purposely no light shadows.  In any case, I'm not seeking anything further than bimax with possible genio.  I'm okay with everything else.

jesterofmalice

  • Full Member
  • ***
  • Posts: 142
  • Karma: 3
Re: Analyze My Cephalometric X-ray
« Reply #17 on: March 03, 2016, 01:07:43 AM »
how old are  you, OP?
Does the  thought of wearing braces for a year or 2 as an adult effect your decision to potentially go through with something like bimax?

JayJaw

  • Newbie
  • *
  • Posts: 49
  • Karma: 3
Re: Analyze My Cephalometric X-ray
« Reply #18 on: March 03, 2016, 06:37:50 AM »
I wonder if that girl simply had additional bone growth to account for some of the facial changes.  Her face just appears wider.


I don't think so. Her width at the back stays the same. It's just that before any width towards the front of her jaw was turned down and back. As it was further back, it looks narrow and being grown down... well, the longer overall look projects narrowness. Look at where the gonial angle is in both front and profile pictures. It remains unchanged. It's just that when you rotate the jaw and the anterior part becomes flatter, it creates a sharper angle from the front and reduces the height that was once making the face look longer and narrow. Plus, it brings that and the chin forward, where it also gives "illusion" of width.

You'll notice she still has severe lip incompetence. But it doesn't even matter because it's not lip incompetence on it's own that's necessarily bad. When your jaws are in the right spot, especially when the jaw is rotated and the teeth are upright and chin is further out... the lip doesn't hang outwards as much and the lips aren't unnaturally open/narrow as they were when the jaws were overly long.

Anyway, that's a great result. The real improvement her eyes which now have more support. I wonder what she got done there or if it's just the upper jaw movement?

Tezcatli

  • Jr. Member
  • **
  • Posts: 83
  • Karma: 5
Re: Analyze My Cephalometric X-ray
« Reply #19 on: March 03, 2016, 07:09:51 AM »
I don't think so. Her width at the back stays the same. It's just that before any width towards the front of her jaw was turned down and back. As it was further back, it looks narrow and being grown down... well, the longer overall look projects narrowness. Look at where the gonial angle is in both front and profile pictures. It remains unchanged. It's just that when you rotate the jaw and the anterior part becomes flatter, it creates a sharper angle from the front and reduces the height that was once making the face look longer and narrow. Plus, it brings that and the chin forward, where it also gives "illusion" of width.

You'll notice she still has severe lip incompetence. But it doesn't even matter because it's not lip incompetence on it's own that's necessarily bad. When your jaws are in the right spot, especially when the jaw is rotated and the teeth are upright and chin is further out... the lip doesn't hang outwards as much and the lips aren't unnaturally open/narrow as they were when the jaws were overly long.

Anyway, that's a great result. The real improvement her eyes which now have more support. I wonder what she got done there or if it's just the upper jaw movement?

According to the book she had Lefort I with advancement and vertical shortening, BSSO with advancement and anticlockwise rotation and genio with advancement and vertical shortening.
While a Lefort I doesn't move the orbital rims the impaction does affect the muscles below the eye because everything is connected in the face and there are a few articles in PubMed saying it does reduce scleral show and vertical eye size in around 10%

Not worth it in your case IMO.

People who get straight advancement barely improve aesthetically unless they are deformed before.

Only people who seem to look alot better after are those who have transverse / vertical deformity. Short/long faces etc.

I don't know, I will get double jaw advancement with impaction too(long face) but my ortho and surgeon said my face should change a lot because of the advancement because my face is flat right now. They even said I may need new ID pictures.

I think OP will look great after surgery.

kjohnt

  • Sr. Member
  • ****
  • Posts: 387
  • Karma: 26
Re: Analyze My Cephalometric X-ray
« Reply #20 on: March 04, 2016, 02:57:25 PM »
how old are  you, OP?
Does the  thought of wearing braces for a year or 2 as an adult effect your decision to potentially go through with something like bimax?

32, and according to ortho no braces needed, but I would get them if needed.  The cost of braces would be the biggest issue IMO as I'd already have to pay out-of-pocket for surgery.

PloskoPlus

  • Hero Member
  • *****
  • Posts: 3044
  • Karma: 140
Re: Analyze My Cephalometric X-ray
« Reply #21 on: March 05, 2016, 12:52:04 AM »
The surgeon can put your bones in the position he wants down to 0.1 of a mm.
Any surgeon who told you this is a liar.

Tezcatli

  • Jr. Member
  • **
  • Posts: 83
  • Karma: 5
Re: Analyze My Cephalometric X-ray
« Reply #22 on: March 05, 2016, 11:21:46 AM »
Any surgeon who told you this is a liar.

Hyperbole, I mean bone is much more precise than soft tissue

PloskoPlus

  • Hero Member
  • *****
  • Posts: 3044
  • Karma: 140
Re: Analyze My Cephalometric X-ray
« Reply #23 on: March 06, 2016, 12:11:15 AM »
Hyperbole, I mean bone is much more precise than soft tissue
Well, just for the record, probably the best surgeon alive told me he can move to within 1mm.

Kambrook

  • Newbie
  • *
  • Posts: 10
  • Karma: 0
Re: Analyze My Cephalometric X-ray
« Reply #24 on: March 06, 2016, 11:26:27 PM »
There's no question that the morph looks better. But it's really just an incremental improvement and it won't change your life significantly. Personally, I don't think it would be worth it if you don't have any functional issues to resolve.

You need to take a "big picture" view of things. Ask yourself this: "How much better would my life have to become for me to consider the surgery worthwhile?" What specific aspects of your life are you hoping will improve? More success with women (or whatever your preference may be)? Making friends easier? Getting promoted at work? Or even just the personal satisfaction of liking your reflection in the mirror better? The surgery would likely improve your life in all of these areas, but only slightly. You need to think very carefully about whether the results obtained will be worth the price paid.

Tezcatli

  • Jr. Member
  • **
  • Posts: 83
  • Karma: 5
Re: Analyze My Cephalometric X-ray
« Reply #25 on: March 07, 2016, 01:55:05 PM »
There's no question that the morph looks better. But it's really just an incremental improvement and it won't change your life significantly. Personally, I don't think it would be worth it if you don't have any functional issues to resolve.

You need to take a "big picture" view of things. Ask yourself this: "How much better would my life have to become for me to consider the surgery worthwhile?" What specific aspects of your life are you hoping will improve? More success with women (or whatever your preference may be)? Making friends easier? Getting promoted at work? Or even just the personal satisfaction of liking your reflection in the mirror better? The surgery would likely improve your life in all of these areas, but only slightly. You need to think very carefully about whether the results obtained will be worth the price paid.

Yes exactly, possible side effects should also be considered. Do not go overboard, in theory you can die during any surgery, but it's very unlikely. However paresthesia, numbness, edema, that is all pretty much guaranteed to some degree.

kjohnt

  • Sr. Member
  • ****
  • Posts: 387
  • Karma: 26
Re: Analyze My Cephalometric X-ray
« Reply #26 on: April 13, 2016, 11:33:54 PM »
Update:

I'm moving forward with the surgery.  I've done various analyses with both x-rays and pictures and without a doubt I could use at least 10mm advancement at the chin and probably more.  If anybody is interested, I can post examples of my analyses to answer the if, but otherwise am more concerned now with the surgery specifics to answer the how.

It's now been agreed upon by surgeon and ortho that I need braces as part of this.  Next Thursday it begins!

Moving Forward:

Using Dolphin imaging software, my orthodontist estimates he can create +4mm overjet (to 6mm overjet from current class I of 2mm) by decompensating my incisors.  He'll also slightly tip outward premolars (and perhaps molars, I'm not sure) because they will fit on a wider part of my lower teeth once the mandible is moved forward.  This will also give me a slightly wider smile!  Anyway, that's set - my mandible will be moved forward +4mm compared to my maxilla at the teeth.

But that won't be quite enough for a nice profile aesthetic.  To take care of the rest:

- My surgeon estimates my best option to be CCW rotation by posterior maxillary downgraft of about 3mm.  This will move my mandible further yet in comparison with maxilla.  No sliding genioplasty.    Tooth show is good so anterior maxillary impaction isn't a good option.

- My orthodontist estimates my best option to be sliding genioplasty.  No CCW rotation because he thinks the posterior maxillary downgraft will result in excess gum show near my molars when smiling.  He checked to see if I have any room to remove some gum tissue on those and I do not; my molars are simply short.

- Neither wants premolars extracted.

So my dilemma is either excess gum show on molars or excess labiomental fold.  At this point I'm inclined to agree with my surgeon.  I understand analyses will need to be done by all parties once my teeth are ready for surgery.  Anyway, I've attached pictures to show current labiomental fold and current gum show (my smile is not usually that lopsided in other pictures and is more symmetrical like my right - or the picture's left - side).  I think the truth is that my lower arch just isn't big enough, but I too don't like the idea of extracting teeth.

Which would be worse... more gum show near molars with CCW rotation or deeper labiomental fold with sliding genio?  If I decide neither are acceptable, it's lower premolar extractions.
« Last Edit: April 18, 2016, 07:05:38 PM by kjohnt »

PloskoPlus

  • Hero Member
  • *****
  • Posts: 3044
  • Karma: 140
Re: Analyze My Cephalometric X-ray
« Reply #27 on: April 14, 2016, 12:21:06 AM »
Who's your surgeon?

kjohnt

  • Sr. Member
  • ****
  • Posts: 387
  • Karma: 26
Re: Analyze My Cephalometric X-ray
« Reply #28 on: April 14, 2016, 12:27:02 AM »

PloskoPlus

  • Hero Member
  • *****
  • Posts: 3044
  • Karma: 140
Re: Analyze My Cephalometric X-ray
« Reply #29 on: April 14, 2016, 02:22:16 AM »
Bloomquist
Good luck, although like I said before, not sure if JS is worth it in your case.