Thanks for your detailed and informative reply. I appreciate it.
I apologize for the crummy pictures. Perhaps this one https://i.imgur.com/HHm3GbR.jpg shows what Dr. Yaremchuk mentioned to me. He told me that I had a combination of shallow orbits as well as a negative vector along with a slightly concave profile. You appear to be far better informed on this topic than I am so I'd like to ask if you see what he's talking about from this picture.
Perhaps it's then my vertically long nose that is leading to the doctors believing that I have a long midface??
I would like to ask a few questions about the jaw recession. I unfortunately never got a straight answer out of my docs, not even how they came to the conclusion that I have recessed jaws. I have read about the nasion and point A. I'm not sure where my nasion is since I do have a 'bumpy' forehead. From what I gather my chin is slightly in front of Point A, which might be in line Dr. Yaremchuk's statement that my profile is somewhat concave. I'm guessing that the angulation of my upper incisors is the camouflage treatment my original orthodontist gave me when I was 11 to fix my underbite, correct? When I view other ceph's I notice that most of the time the top of the roots of the incisors are slightly in front of the orbital bone, mine are further back. Could this perhaps point towards some recession/retrusion of the maxilla?
Thanks for the information on the burring of the bone. Yeah, I might want to reconsider that. I want to add one last picture taken by my orthodontist and I also showed this picture to Dr. Yaremchuk which led to his statement about jaw implants and also telling me that my face is quite narrow. My orthodontist told me to try to smile/expose my teeth as much as possible so it looks unnatural. https://i.imgur.com/G4xZyqm.jpg Yaremchuk said that he could tell that my jaws were too narrow because when most people smile the back of the mandible 'sticks out' a bit. My ramus and back of the jaw curves inward, which is also somewhat evident from my frontal picture. I'm not willing to take too many risks here, but would you agree with his assessment that my jaw is too narrow for my face? Could this be a result of incorrect tongue posture as a kid?
Thanks again for your time.
OK,prior, i said you had pretty much a 0 vector. That photo shows a bit less than a 0 vector. But I would not call that 'prominent' or 'buldging' eye. But still, you could have the ORIs. A midface lift goes with them as he has to re-hoist the soft tissue to a higher level for fixation. From the photo, it looks like you have enough of a sagittal cheek curve at a LOWER LEVEL that could be hoisted up with the midface lift that 'goes' with the ORIS. That would give you an improved sagittal curve.
No idea why they are telling you 'long' midface. My relative measures (on front face photo) kicked up equal '1/3rds'.
As to where your nasion is, 'N point', along with A, B, S and Pog points, I've marked out approx where they are on your ceph. I'm getting approx norms for the angle measures albeit with hand held protractor, hence APPROX. These are just relative angle relationship measures. As I said prior, perhaps the doctors are using an 'absolute' measure to tell you both jaws are recessed. Relative to a straight vertical dropped from N point, you don't see relative recession. Even if you drop a vertical from forehead prominence, you still have a good line up.
For example, let's say there is an 'absolute' distance between S and N (for a given angle) and your distance is less than that absolute. Well, then you could say both jaws would be 'recessed' according to an absolute.
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From what I gather my chin is slightly in front of Point A, which might be in line Dr. Yaremchuk's statement that my profile is somewhat concave. ]
Chin point (Pog) being slightly in front of A point AFAIK is not how they look at recession of maxilla. They look at ANB angle.
With regard to Dr. Jamali telling you that surgical corrections for your case would be 'difficult' and very risky, there would be no way for you to tell IF that were true for another max-fax with more experience and advanced skill set. For example, Gunson is considered one of the best in the US and is known for doing some advanced manuever displacements run of the mill max fax docs don't do. Yet Jamali did not give that referral to explore.
That said IF you wanted to FURTHER explore max-fax option, now that you have info that Jamali told you it was 'difficult', a good cross reference for that IN TERMS of doctors who DO the bi-max surgery would be to consult with Gunson who can do 'difficult' things or movements that are 'difficult' for other max fax docs to do.
Since a Lefort 1 would leave the ORIS and cheeks 'behind' IF you opted for bi-max. Nothing wrong with getting the ORIS now if you wanted. They would not interfere with a later decision to get the bi-max. Chin and jaw implants would interfere with it though.
BUt IF you really WANT bi-max and GAVE UP on the possibility based on what Jamali told you BUT later found out (after you had chin and jaw implants) that you COULD HAVE had the bi max (with a more experienced max fax than Jamali), best to cross reference is opinion with Gunson.
You could have jaw implants to make your jaw to jaw distance wider. But if they have to also be dropped lower to do that, the chin would also need to be altered with implants to blend. As i said, you have a nice horizontal line base to the chin which makes your face in repose look angular from the front. I have no idea if the 'bony irregularities' to your chin he refers to is the SAME straight line contour to the chin base that I think look great and/or if those are things he would need to burr down so an implant with base of an ARC would fit better. If that's the case, you could just get a wider ARC to the lower face in exchange for the angularity you presently have.
So, I guess it depends on whether or not you gave up on further exploring the bi-max option based on what Jamali told you or just resolved never to have bi-max and want your face built up with implants.
My personal opinion would be to start with the ORIS and re-evaluate the other implant options or other possible options for bi-max later. The ORIS would give some improvement and blend in with the rest of your face AS IS. You don't want a situation where if he puts in cheek implants, he THEN ALSO has to put in other midface implants below that to match with them and if he does that, then the lower face will look too narrow and recessed by comparison and then, the jaw and chin implants have to put in to match that or do you?
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