Author Topic: Merits of aesthetics bimax  (Read 7997 times)

ditterbo

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Merits of aesthetics bimax
« on: January 08, 2017, 02:23:51 PM »
If one has a very dolichocephalic skull pattern, retrognathia, very mild maxillary retrusion, no anterior maxillary excess, basically no ramus, and lastly, a mandibular plane angle of 40 degrees, how would bimax w/CCW rotation be of much aesthetic benefit over camouflage procedures like SG, implants, or chin/side wings?  I'm describing myself but this may be the case of other 'borderline' people. Because like if you can't impact the anterior maxilla, then how are you benefiting from the CCW rotation with just a posterior downgraft alone for the rotation? Your mandibular plane angle won't change much at all. People say the biggest aesthetic benefit of bimax is from CCW and not straight forward advancement.  Sure straight forward advancement helps, but can't that be masked with plastic surgery?  In fact I'm already considered 'well compensated' by some with a 12mm chin implant and rhinoplasty, both I did before realizing I had retrognathia.

For instance, Gunson's plan for me is no maxilla anterior impaction, but about a 10mm posterior downgraft.  15mm lower jaw, 2mm upper jaw, and 3mm SG.  That gets me 6mm more at the pogonion vs my current profile before you consider a less than perfect surgery, which could easily get me back to within 2-3mm of my current chin.  Also my mandibular angle plane would barely change. It'll be 5 degrees better if that.  That's due to the lack of maxilla anterior excess to impact, which would then let the lower jaw come up and reduce the MPA.

So if I were to get bimax hoping for it to be my last surgery with a ~2 point looks gain, I think I'll come out very disappointed.

The benefits of CCW, as I understand it, is to shorten the face thereby helping fill in the mid-face and getting you a more naturally forward-growth pattern looking jaw.  You get this by BOTH posterior maxilla downgrafting AND anterior maxilla impaction for the full CCW rotation.  One without the other significantly reduces the aesthetic potential of a textbook CCW movement.  Great I don't have a gummy smile to start with, but that means bimax won't do much more than this chin implant is doing for me already.  My jaw angle will still be steep and probably not anymore defined because it's so narrow and seriously dolichocephalic. 

Counter argument is if you look below average anyways, then you'll need bimax just to get a 'normal' face to only then improve upon vis-a-vis PS.  So then you're looking at bimax followed by a face full of implants or osteotomies as you see fit.   As I stand now without any nagging medical issues to also address with bimax, I don't want use bimax solely as a cosmetic 'gateway' surgery to the actually helpful cosmetic ones.  Without medical problems, it may be 'close enough' to augment what I already have and call it a day.  Probably just fix my nose, think hard about a side wing + ZSO from Dr. Z, and be done. 
« Last Edit: May 06, 2017, 08:44:27 PM by ditterbo »

jawregret

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I looked basically exactly like you before. Was also pretty 'borderline'.

I had bimax with anterior impaction to achieve CCW rotation, except had no gummy smile like you.

HORRIBLE IDEA.


diculo

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I looked basically exactly like you before. Was also pretty 'borderline'.

I had bimax with anterior impaction to achieve CCW rotation, except had no gummy smile like you.

HORRIBLE IDEA.

Why do you regret your surgery? Did the bimax w/ CCW rotation not do anything?

ditterbo

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Quote
Why do you regret your surgery? Did the bimax w/ CCW rotation not do anything?

I'm proposing a full CCW rotation can't be achieved when you don't already have a gummy smile.  It requires impaction of the anterior maxilla to get the full aesthetic benefit of both absolving the gummy smile AND just as importantly, decreasing the sharp mandibular plane angle (if you have one like me). 

He didn't have a gummy smile but still got full CCW.  If I'm understanding this rotation correctly, he probably got a great aesthetic improvement until he opens his mouth and reveals almost no teeth. Not sure but maybe the loss of maxilla in the front could have messed up some other areas due to less support.

jawregret

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I'm proposing a full CCW rotation can't be achieved when you don't already have a gummy smile.  It requires impaction of the anterior maxilla to get the full aesthetic benefit of both absolving the gummy smile AND just as importantly, decreasing the sharp mandibular plane angle (if you have one like me). 

He didn't have a gummy smile but still got full CCW.  If I'm understanding this rotation correctly, he probably got a great aesthetic improvement until he opens his mouth and reveals almost no teeth. Not sure but maybe the loss of maxilla in the front could have messed up some other areas due to less support.

I'm not a guy, but that's precisely what happened. I got a very strong jaw now (as a female, not sure how I feel about this), but no upper tooth show at all, while my lower teeth are visible up to the gumline.. As well, the impaction does seem to have caused a loss of support in the midface even though I had a slight forward movement to supposedly mitigate that.

thinkingme

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we have a little simular situtation mb u remember. same head shape(long) only my upper third bigger than you, fu*k balding

 what is ur plans and what are you doing now. i forgot my jaw problem for 2-3 month cuz that stress last year and genetics made me balder so fast.

i did a consult and still cant decide. doc didnt say anything %100. He said ''looks like ccw  but mb genio and if u dont want them,then just braces''.

i really want your surgery before after photos and then want to decide mine :D. i have same problems with you plus giant head


ditterbo

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we have a little simular situtation mb u remember. same head shape(long) only my upper third bigger than you, fu*k balding

 what is ur plans and what are you doing now. i forgot my jaw problem for 2-3 month cuz that stress last year and genetics made me balder so fast.

i did a consult and still cant decide. doc didnt say anything %100. He said ''looks like ccw  but mb genio and if u dont want them,then just braces''.

i really want your surgery before after photos and then want to decide mine :D. i have same problems with you plus giant head

0 plans, no ones told me otherwise that bimax is more than just a gateway procedure to get actual appearance improving surgery. Particularly for my case where I think I've probably already gained 90% of the improvement you can reasonably expect after an actual bimax case (not talking projections where relapse and soft tissue thinning isn't accounted for).  Going through my recording again from the Gunson consult, Gunson's medical reasoning for bimax is quite dubious, basically ludicrous IMO. 

He claims I wear my back teeth out more due to my lower jaw moving forward to form my habitual bite (can't get an ortho or dentist to agree on that), my teeth are almost in their natural position, incisors are where they're supposed to be, my airway is fairly large with smallest point being 186mm. but "you've already experienced the pitfalls of camouflage treatment and the unintended consequences"   "every issue taken in isolation isn't needing jaw surgery, but diagnostically, it's worth it" - Gunson. 

I don't know if it's good or bad that I went the PS route over bimax.  The "only" downside to the PS is my smile is now tight and slightly asymmetric.  Bimax could've traded off a lot more functionality and sensation for nearly the same results.  I dono anymore, venting a bit and frustrated with this lack of clear reasoning to do bimax. Too many variables and unknowns. My chin implant can start drilling into my bone in 2 years and then I'll all of a sudden need to do something.

kjohnt

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Re: Merits of aesthetics bimax
« Reply #7 on: January 27, 2017, 05:54:50 PM »
You don't need any impaction at all to achieve ccw rotation if your gum show is already good.  Just posterior downgrafting.

PloskoPlus

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Re: Merits of aesthetics bimax
« Reply #8 on: January 27, 2017, 06:33:24 PM »
You don't need any impaction at all to achieve ccw rotation if your gum show is already good.  Just posterior downgrafting.
But then you need A LOT of it. And it would have to be porous ha.

ditterbo

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Re: Merits of aesthetics bimax
« Reply #9 on: January 28, 2017, 07:41:04 PM »
You don't need any impaction at all to achieve ccw rotation if your gum show is already good.  Just posterior downgrafting.

See the surgical plan I posted from Gunson at start of thread.  It's almost 10mm of a posterior downgraft but it barely changes my mandibular angle.  So what's the aesthetic improvement in that CCW?  If I'm lucky, someone like Posnick, who prefers much milder CCW, would advance my jaws with just enough CCW to keep my current long face. Gunson's posterior downgraft is severe enough to actually shorten it but not by much at all considering where I'm starting from. 

I've either hit the ceiling in what I need to know with bimax in my case (doubtful) or the veteran forum goers aren't taking much interest in this thread. Has anyone seen before/after of others with the same skull pattern and slanted off ramus?

I might make new profile shots. Something about the ones Gunson made of me I just can't reproduce at home.  Might just be my heads held higher.

PloskoPlus

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Re: Merits of aesthetics bimax
« Reply #10 on: January 28, 2017, 08:00:23 PM »
See the surgical plan I posted from Gunson at start of thread.  It's almost 10mm of a posterior downgraft but it barely changes my mandibular angle.  So what's the aesthetic improvement in that CCW?  If I'm lucky, someone like Posnick, who prefers much milder CCW, would advance my jaws with just enough CCW to keep my current long face. Gunson's posterior downgraft is severe enough to actually shorten it but not by much at all considering where I'm starting from. 

I've either hit the ceiling in what I need to know with bimax in my case (doubtful) or the veteran forum goers aren't taking much interest in this thread. Has anyone seen before/after of others with the same skull pattern and slanted off ramus?

I might make new profile shots. Something about the ones Gunson made of me I just can't reproduce at home.  Might just be my heads held higher.
I was pro surgery wrt your case before... Now I'm not so sure. Maybe had you not had all that camouflage work to begin with. (BTW, The dipping upper lip after rhinoplasty is surprising . I know the muscles may be effected, but not too that extent.)

IMO, what seems to affect your looks the most from the front is the rather long midface. Since that's mostly the nose, I'm not sure what can be done about that.

ditterbo

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Re: Merits of aesthetics bimax
« Reply #11 on: January 28, 2017, 08:39:35 PM »
I was pro surgery wrt your case before... Now I'm not so sure. Maybe had you not had all that camouflage work to begin with. (BTW, The dipping upper lip after rhinoplasty is surprising . I know the muscles may be effected, but not too that extent.)

IMO, what seems to affect your looks the most from the front is the rather long midface. Since that's mostly the nose, I'm not sure what can be done about that.

I thought I linked it but here's Gunson's plan: http://i.imgur.com/xFym2lf.jpg

The upper lip affect is probably from the columella strut graft used in the rhino to project the tip. I'd like to revise my nose but I'm holding out while running this bimax decision to the ground.  But ya the long face thing is hard for to work out.  It gets worse as I lose fat in my mid-face with aging + immediate upper cheek hollowing caused by the rhino.  I took a pulse oximeter test overnight, at home, and I don't have sleep apnea. The sleep study test probably diagnosed mild apnea while I was forced to sleep on my back per protocol.
« Last Edit: January 28, 2017, 11:40:47 PM by ditterbo »

PloskoPlus

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Re: Merits of aesthetics bimax
« Reply #12 on: January 29, 2017, 07:12:52 PM »
Longer midface is OK provided you're tall.

PloskoPlus

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Re: Merits of aesthetics bimax
« Reply #13 on: January 29, 2017, 08:50:51 PM »
That's a big rotation. Whether the translates into a big change in how you look... I don't know. I suspect that it will. Just for reference his revision plan for me had much smaller net changes everywhere... Probably why he felt it was not quite worth it in my case.

ditterbo

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Re: Merits of aesthetics bimax
« Reply #14 on: February 05, 2017, 07:46:17 PM »
Not tall, 5' 9". I think the long face affect is amplified by my hanging columella / retracted nostrils...

It's a big posterior rotation, requiring the 2 or 3 piece lefort to accomplish (forgot which he selected), but I don't see how this would be much improvement over the current chin implant.  I see the rotation improving the gonial angle very slightly, which would also improve my mid-face slightly, but that's it. Slight enough I'm afraid I would look no different except to those closest to me.

 Also, from this forum, sounds like his HA approach does hardly anything helpful for the mid-face and is a waste of money. 
« Last Edit: February 05, 2017, 08:55:31 PM by ditterbo »