Lefort1 cut, ccw and nose altering

[april]

BINGO!  She didn't get a BSSO and got chin instead. She got single jaw surgery with genio. It's just that we don't know circumstances of not doing the BSSO. Doctor's design or patient desire to avoid it?   Like what if the patient was afraid a BSSO would have made her look 'more masculine' and attributed a more 'heart shaped' face with being more feminine.

I mention that because the outcome looks like it could have resolved to SOMEONE making those types of associations and I've seen those types of auto-associations made on this board.

Point taken Kavan

Although I'm going to go with doc design here because 1) 95% of regular patients just go along with whatever the first surgeon they see says, and don't think critically about it 2). Her surgeon put her result up on his website, and first result, no less - he must think she looks pretty good and 3) assuming their aim was also to get her bite right, you can't just do a genio in lieu of a BSSO when one is needed for that. So presumably her bite fits w/o a bsso?

[kavan]

Point taken Kavan

Although I'm going to go with doc design here because 1) 95% of regular patients just go along with whatever the first surgeon they see says, and don't think critically about it 2). Her surgeon put her result up on his website, and first result, no less - he must think she looks pretty good and 3) assuming their aim was also to get her bite right, you can't just do a genio in lieu of a BSSO when one is needed for that. So presumably her bite fits w/o a bsso?

Well, on the other hand, her photo would not be up there either if she, the patient wasn't happy with it. So, yes, the situation would have been one where the upper jaw surgery alone affected the bite to be right. But I'm not so sure it was one where there was no option to alter the displacements to the upper jaw such that a BSSO could have been done. Do you think that Gunson would have found a way to displace upper jaw differently so a BSSO could have been done (with right bite there too) as to avoid the chin exaggeration she has from the front?

[april]

Well, on the other hand, her photo would not be up there either if she, the patient wasn't happy with it. So, yes, the situation would have been one where the upper jaw surgery alone affected the bite to be right. But I'm not so sure it was one where there was no option to alter the displacements to the upper jaw such that a BSSO could have been done. Do you think that Gunson would have found a way to displace upper jaw differently so a BSSO could have been done (with right bite there too) as to avoid the chin exaggeration she has from the front?

You're right, she must be happy too. That's a good thing at least.

Yeah Gunson would've displaced both jaws. Maybe he would've done a larger rotation and then used multisegement to reposition the front teeth after that. Idk, I can't really guess what he would do, except that it would be DJS. He has a lot of tools at his disposal, this guy might not. Although in me saying that, that's not an excuse at all for this guy to disregard her front view when planning such a genio.

[kavan]

You're right, she must be happy too. That's a good thing at least.

Yeah Gunson would've displaced both jaws. Maybe he would've done a larger rotation and then used multisegement to reposition the front teeth after that. Idk, I can't really guess what he would do, except that it would be DJS. He has a lot of tools at his disposal, this guy might not. Although in me saying that, that's not an excuse at all for this guy to disregard her front view when planning such a genio.

Well, your main guess that G would do double jaw seems right to me. Some of his displacement proposals do a LOT as to make the chin augmentation as minor as possible.

Does this one look less weird?

[ben from UK]

Not more than 2mm of nostrils should be visible from the front. That's the 'geometrical' rule, like facial thirds (1/3rd). Her lower third was too long as well. I reduced the chin length.

Still not a very good morph. Was difficult to morph the nose.

[april]

She looks much better with a shorter chin. More like herself.

[april]

Back on topic, I found out something interesting while reading an article by Raffaini. He often does a modified le fort called a 'subspinal' osteotomy. It's a lower le fort (I think the cut dips below ANS) and the nose isn't supposed to be affected as much. The incisions are also less invasive (they tunnel through avoiding some of the muscles).

But he also does cosmetic rhinos so it's hard to know if his noses truly get affected or not.

A surgeon I saw last year was trying to explain the same thing to me about tunneling through and not needing to worry about the nose but I had no clue what she was talking about, so I kinda checked out. One of her patients did have a much wider nose afterwards so maybe it's not fool proof.

Looking at the two Alfaro 3d plans posted on this forum, he also cuts just below ANS.

[PloskoPlus]

Exactly, that obsession with the 'good bite' and the 'fixing the bite card' to justify it if things go wrong, or to justify the whole operation in the first place. Who wants a 'good bite'? Apparently I have had a 'bad bite' for all these years and it never bothered me a bit. What bothers me is aesthetics and, recently, some breathing issues but so far I have no evidence that it's jaw related (still trying to work that one out).

I am new here and don't know your story, sounds like you had some bad experiences with surgery? Did you write more about that somewhere on the forum?

Well, my bite did not bother me either.. But now that I have a "good bite", I wouldn't want to go back to my old bite.  So a "good bite" surgery with a mediocre aesthetic result can ironically be one of the worst places to be - you don’t like the way it looks, but can't stomach the risk of ending up with a worse bite. And when you talk with surgeons about a revision you get a completely different perspective on how likely a good bite is. Before surgery they make it sound that a good bite is a sure thing. After surgery - "but you'll be risking your bite!"... "A good bite doesn't always happen", etc.. this really makes one think that you can go though all this hell FOR NOTHING - look no better, possibly worse, no improvement in occlusion, possibly worse... and nerve damage, which my fat surgeon claimed was a 10-12% thing, but which in reality is all but guaranteed after a certain age.

[Dogmatix]

Well, my bite did not bother me either.. But now that I have a "good bite", I wouldn't want to go back to my old bite.  So a "good bite" surgery with a mediocre aesthetic result can ironically be one of the worst places to be - you don’t like the way it looks, but can't stomach the risk of ending up with a worse bite. And when you talk with surgeons about a revision you get a completely different perspective on how likely a good bite is. Before surgery they make it sound that a good bite is a sure thing. After surgery - "but you'll be risking your bite!"... "A good bite doesn't always happen", etc.. this really makes one think that you can go though all this hell FOR NOTHING - look no better, possibly worse, no improvement in occlusion, possibly worse... and nerve damage, which my fat surgeon claimed was a 10-12% thing, but which in reality is all but guaranteed after a certain age.

If you're trying to fix something that's broken, the worst case is that it will be broken in another way and there's really no alternative than trying to fix it. Yes, things can of course always get worse, but you understand it's another risk/reward trying to fix something that doesn't really need to be fixed. I would also prefer to do surgeries where there is a problem to solve, than trying to not f**k up what is already good. I think this is can be a reason for the differens responses.