CCW rotation effect on lips and philtrum

[some1afterall]

Lyra had her original surgery with Dr Felice O'Ryan at Kaiser Oakland. Her revision was done with Dr Nestor Karas in Walnut Creek.

I also had my original surgery with Dr Felice O'Ryan at Kaiser Oakland. My results weren't as bad as hers, but I still have lip incompetence/strain, left TMJ pain, and my face looks even longer post surgery. If I could go back in time I wouldn't of had surgery at all.

Right now I am consulting with many surgeons and trying to read and educate myself so that I don't go in blind if I decide to go through with a revision. Right now revision surgery looks like either 1) a total upper and lower revision with small CCW rotation and forward movement + a genio revision with reduction in vertical length OR 2) genioplasty revision alone with vertical shortening and removal of bsso hardware and smoothing of some of the side notches leftover.

I may not go through with any revision - but right now I'm doing my due diligence.

[Lazlo]

Lazlo,

I don't think you've misunderstood the whole situation.

Wait I just reread her post and pics, its a little confusing. She had a consult with Gunson and analysis but didn't have any surgeries done by him it seems. She only had the consult to analyze if there were any mistakes made. Is this correct Kavan?

[kavan]

Wait I just reread her post and pics, its a little confusing. She had a consult with Gunson and analysis but didn't have any surgeries done by him it seems. She only had the consult to analyze if there were any mistakes made. Is this correct Kavan?

Lazlo,

I did NOT say anything in my post to her about Gunson. No idea how you drew that conclusion.

My first post to her in this string was out of frustration where despite my reading through her over 40 posts, I was unable to put the 'WHOLE' of her situation together due to the presentation of it which I found too confusing. For example, in past posts she mentioned she was satisfied with the function of her bite and in a NEW one in this string it was lip dysfunction. Presentations where some info is conflicting or there is absence of 'hard' info in the history and/or timing gaps of when info is presented makes it hard for me to help someone.

None the less, as of RECENT, she has presented some HARD info (the CT scans) which give me more information that I can (eventually) help with.

[some1afterall]

This is why I think surgeon did CW rotation. Philtrum lengthened, no change in angle, if anything it seems steeper. Keep in mind there is a genioplasty that is helping somewhat with projection.



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[april]

Surgical movements aside, you can see that in your before ceph your maxillary incisors were proclined, holding up your lip.
In the post-op ceph they now look upright. This can cause the lip to look longer just as PloskoPlus has said.

Is your top lip thinner now too? This s**t happened to me with just braces.

[some1afterall]

@ April, yes totally. I’ve thought about the effect the open bite, proclined teeth had on my upper lip area. Maybe the longer philtrum is just par for the course (unfortunately).

[kavan]

OK, now that you present the 'hard' info (the X rays), this certainly yields more information than 'speech'in so far as what I could put together based on your past many posts. For example, your first post emphasized the gummy smile and 'horse face' which stuck in my memory the most where such would be corrected via CCW anterior impaction. Also, it was only recent you mentioned lip DYSFUNCTION (lip incompetence) where as prior, you said your function was fine. So given that there is the presence of more 'hard' info where that was once absent, I'm happy to share some feedback with you.

Indeed, those cephs make it's much clearer that the maxfax did a net counter clockwise rotation in addressing the  anterior open bite. The change in orientation of the ANS-PNS is there to see. You were used to seeing your upper lip somewhat hoisted outward via the outward inclination of the upper front teeth which will make it look shorter from frontal view. So, some CCW done in a revision surgery would give better support to your lip. But since the way you liked it before any surgery was a function of how flared out the front teeth were with the anterior open bite, I can't predict if doing so will kick up what you were used to seeing in the mirror prior but rather suggest you don't count on that.

In so far as CCW to the maxilla revision which he suggests, the mandible will rotate by pretty much the same degree the CCW to the maxilla is (approx). However a FEW degrees doesn't compensate for a very high angle mandibular plane.

As far as predictions go with regard to the chin, in particular with Gunson getting the chin to appear shorter in frontal, which he does to compensate for apparent longness of the face, he probably would want to redo the chin via a diagonal cut where it's slid upward where one vector of displacement that way is vertically SHORTER and the other is horizontally projected. IMO, that would look better on you and the right thing to do to help lip incompetence; strain in getting your lower lip to move up to close with the upper.

All in all, I think Gunson has a good capacity to IMPROVE on that prior doctor's surgery, give you better upper lip support, decrease the apparent excess length coming from the chin area and also make it easier for you to close your lips. But I don't think it's going to 'return' you to what you liked seeing in the mirror from ONLY the FRONTAL view which I mention in the event that's what you want to see it doing.

[some1afterall]

Thanks for your lengthy reply.

My teeth are straight now, my bite is pretty closed, about a 1mm overjet.  Honestly, I knew I strained to close my lips but I didn’t realize exactly how much incompetence I had until my consult with Gunson where he had me fully relax my mouth, jaw and lips, which resulted in 10mm of upper and lower tooth show.

I knew the aesthetics weren’t what I had thought they would be, as I felt like my face looked longer and my lips seemed thinner, especially my lower lip after the genioplasty. I’m starting to see that jaw surgery isn’t the miracle surgery I thought it would be, I’m still stuck with my genetically imposed limitations, but there is something to say about facial bone structure. I have strong cheekbones and I think balanced facial proportions and less strained lips would do me a solid.

The X-rays and professional pre/post op photos are useful because I’ve come to realize that many of my personal pre-surgery photos were from flattering angles.

I’m consulting with another surgeon tomorrow then hope to meet with Relle in the future.

[Lazlo]

Thanks for your lengthy reply.

My teeth are straight now, my bite is pretty closed, about a 1mm overjet.  Honestly, I knew I strained to close my lips but I didn’t realize exactly how much incompetence I had until my consult with Gunson where he had me fully relax my mouth, jaw and lips, which resulted in 10mm of upper and lower tooth show.

I knew the aesthetics weren’t what I had thought they would be, as I felt like my face looked longer and my lips seemed thinner, especially my lower lip after the genioplasty. I’m starting to see that jaw surgery isn’t the miracle surgery I thought it would be, I’m still stuck with my genetically imposed limitations, but there is something to say about facial bone structure. I have strong cheekbones and I think balanced facial proportions and less strained lips would do me a solid.

The X-rays and professional pre/post op photos are useful because I’ve come to realize that many of my personal pre-surgery photos were from flattering angles.

I’m consulting with another surgeon tomorrow then hope to meet with Relle in the future.

Why are you going to consult with yet another surgeon? Your aesthetics have improved and your bite is good/perfect.

Have you become addicted to surgery or something?

[Lazlo]

Lazlo,

I did NOT say anything in my post to her about Gunson. No idea how you drew that conclusion.

My first post to her in this string was out of frustration where despite my reading through her over 40 posts, I was unable to put the 'WHOLE' of her situation together due to the presentation of it which I found too confusing. For example, in past posts she mentioned she was satisfied with the function of her bite and in a NEW one in this string it was lip dysfunction. Presentations where some info is conflicting or there is absence of 'hard' info in the history and/or timing gaps of when info is presented makes it hard for me to help someone.

None the less, as of RECENT, she has presented some HARD info (the CT scans) which give me more information that I can (eventually) help with.

Kavan, I was just asking if Gunson had operated on her. Then I realized I had misread her post and she had only had a consult with Gunson. I was asking you to confirm since you ostensibly would have known the thread much more intimately having posted it yourself.

So please b*tch, don't hate the playa, hate the game.

[some1afterall]

Why are you going to consult with yet another surgeon? Your aesthetics have improved and your bite is good/perfect.

Have you become addicted to surgery or something?

I’m consulting with more than one surgeon to see if they all agree on a revision. It’s not like I want to spend $$$ and get braces again and go through jaw surgery again, but if Gunson thinks I have a case than it’s worth looking into.

Things don’t feel/look right to me. Sometimes are better than others.

Far away with good makeup some angles look nice. I don’t know, jaw surgery is an f’k up thing for a lot of people to get into.

I want to hear your story, Lazlo.

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[some1afterall]

I think my husband is tired of hearing me b*tch about my jaw so it feels nice to share the company of others that are going through this s**t.

[kavan]

Kavan, I was just asking if Gunson had operated on her. Then I realized I had misread her post and she had only had a consult with Gunson. I was asking you to confirm since you ostensibly would have known the thread much more intimately having posted it yourself.

So please b*tch, don't hate the playa, hate the game.

Oh, OK. Thanx for clarifying. I guess there was a lot of confusion going on.

[kavan]

Thanks for your lengthy reply.

My teeth are straight now, my bite is pretty closed, about a 1mm overjet.  Honestly, I knew I strained to close my lips but I didn’t realize exactly how much incompetence I had until my consult with Gunson where he had me fully relax my mouth, jaw and lips, which resulted in 10mm of upper and lower tooth show.

I knew the aesthetics weren’t what I had thought they would be, as I felt like my face looked longer and my lips seemed thinner, especially my lower lip after the genioplasty. I’m starting to see that jaw surgery isn’t the miracle surgery I thought it would be, I’m still stuck with my genetically imposed limitations, but there is something to say about facial bone structure. I have strong cheekbones and I think balanced facial proportions and less strained lips would do me a solid.

The X-rays and professional pre/post op photos are useful because I’ve come to realize that many of my personal pre-surgery photos were from flattering angles.

I’m consulting with another surgeon tomorrow then hope to meet with Relle in the future.

I was initially thrown for a loop due to the verbal emphasis on 'gummy smile' and long or 'horsey face' in your description in other posts as that being the main reason for your surgery (in which CCW, anterior impaction used to correct). That and the convex profile and bite which were corrected. So, yes. It was the presentation of the before and after cephs (at a later time) that made things more clear to me that the surgery prioritized the open bite as the main focus of  correction. Hence, net rotation was CW used to close an open bite which is also visible in the before/after X rays.

So, now, it's even more clear that one aspect you LIKED about your original smile and the philtrum contour that looked visually shorter was due to the EXTENT of the open anterior bite, where the philtrum was oriented diagonally to project shorter. Closing the anterior open bite, (which the prior surgery did indeed correct), came with trade-off of your philtrum being oriented along with the front teeth on a more vertical plane which made it look longer. Also, the genio which was not the type where the chin is slid upward along a diagonal cut (where doing so makes it look vertically shorter and horizontally advanced) was not the type to visually compensate for 'longness' seen from frontal.

What you need to clarify/reconcile in your own mind is your 'attachment' to the aspects of your face that you LIKED but were contingent on the PROBLEMS you got corrected, eg. you liked but missed the way the extent of the open anterior bite made your philtrum look shorter and how the extremely convex profile with a lot of chin recession made your chin look shorter too. Hence, a surgery aimed at addressing and making less the TRADE-OFF you got from the anterior bite being corrected (like Gunson's proposal for some CCW to do that) and also the chin correction he would do, won't also bring back what you liked seeing in the mirror in frontal view given what you like seeing in the mirror in front view was directly related to what any surgeon would want to correct but not to 'return' to you.

[april]

I really think surgeons and orthodontists need to better inform their patients of the trade-offs. This all makes complete sense in hindsight - once the problem has been deconstructed - but when signing up to ortho & surgery most wouldn't be aware at all of the potential soft tissue changes.

In every consult I've been in I have only ever been asked about what I DON'T like -- not once have I been asked what I DO like.

Granted I haven't consulted with Gunson, and I know he likes to maintain aesthetics.

If I had been told prior to signing up to ortho that my upper lip would become thinner, longer and cover more teeth, I think I would've walked away because I liked my fuller upper lip and smile. Yes it's ridiculously obvious now that it's exactly what happens when you make teeth more vertical, but it didn't even cross my mind until it was too late.