Bimax for aesthetics, looking for advice

[djsbelgium]

I’m looking to correct my deep bite and receded jaws. My side profile: https://imgur.com/a/rd67uiv . Looking for some input.

I used to have a way wider face (see https://imgur.com/a/NKP75VS). I believe i started mouth breathing and my face sunk. I do look better now (i had nasal surgeries plus better tongue posture practice) but i believe i always had a deep bite and an off-centered midline. I’m looking to correct as much as i can.

I’m currently looking at double jaw surgery but also considering getting sarpe for both jaws or zygoma work / gonial angle implants.
I’m not sure every jaw surgeon does lower sarpe, i know dr Mommaerts does. Do they do it for aesthetic purposes as well?

My surgeon made this quick plan ( https://imgur.com/a/IWR05fR) for me. As you can see, ccw, 5,5mm maxilla advancement, 8mm mandible advancement. But this plan is based on a scan where i didn’t have braces. He said the plan might change a bit once i get my teeth properly aligned for jaw surgery. He said his biggest limit is tooth position.

He said genioplasty is not needed and that my chin is good by the standards (he uses Arnett&Gunson analysis). I’m not sure if this is the best aesthetic outcome. Wouldn’t it be more aesthetic if the chin reaches as far out as the lips ?

I’m not sure if my current surgeon has an eye for aesthetics. He keeps drilling me the sentence ‘jaw surgery is a functional surgery, not aesthetic’. While i do understand that i’m worried he undervalues the aesthetic component of the surgery. He also wasn’t keen on answering aesthetic questions such as « does bimax advancement reduce cheekbone definition ? » .

I made an appointment with dr Defrancq (who is also a plastic surgeon). I’m sure he has more of an eye for aesthetics. I’ll see what he says. I might look into implants as well if the price is right. But if he has the same advancements planned as my current surgeon then i’ll just do it with my current surgeon. He does 100 surgeries a year plus 50 as an assistant.

[Post bimax]

When were those pics in the 2nd link taken? Can't see your eyes but you look aesthetic there imo.

[djsbelgium]

When were those pics in the 2nd link taken? Can't see your eyes but you look aesthetic there imo.

2nd link: on the left after mouth breathing, on the right before mouth breathing
On the right i was still in highschool, on the left was like 2-3 years later

It helps if you have other aesthetic qualities to hide jaw deficiency.

[kavan]

You should put ALL your photos on the same Imgur link. If IMGUR allows text descriptions below the photo(s) which I think it does, you should do that too.

Sorry but using a separate imgur link for EACH photo tends to disorder any attention I could give as it requires multi separate tabs to be open and flitting back and forth to the question and descriptions on the post for reference.

[Post bimax]

2nd link: on the left after mouth breathing, on the right before mouth breathing
On the right i was still in highschool, on the left was like 2-3 years later

It helps if you have other aesthetic qualities to hide jaw deficiency.

It would be helpful if you just blotted your eyes out or something because the large white rectangles cover up important features for assessing overall facial balance.

[djsbelgium]

You should put ALL your photos on the same Imgur link. If IMGUR allows text descriptions below the photo(s) which I think it does, you should do that too.

Sorry but using a separate imgur link for EACH photo tends to disorder any attention I could give as it requires multi separate tabs to be open and flitting back and forth to the question and descriptions on the post for reference.

https://imgur.com/a/ZlHMaxD

[Post bimax]

IMO the plan looks good but I agree with your concern about the genioplasty.  BSSO with CCW will improve your profile but I'd personally get a genio to have your chin meet or exceed your lip by 1 or 2 mm.

[kavan]

https://imgur.com/a/ZlHMaxD

OK. Thanks for the better organization.

What I can say is that your recent self photo (first in series) and your ceph do look consistent with the ceph displacement plan your surgeon made for you as to the proposed  changes which are of course preliminary and ultimately will be contingent on the extent of what the braces will do to prepare you.

I think it also needs to be pointed out that a doc who DOES use the Arnett system (which you correctly point out is that of the ceph displacement diagram) IS using a type of analysis that is BASED on maximizing aesthetics. As to the chin, with SLIDING genio, that would advance out more but it would ALSO tend to SHORTEN the chin which would explain why your doc did not suggest chin advancement. Sliding genios that both advance out chin and vertically shorten chin are not suggested for people with the 'deep bites' because they usually have 'short chin' with that. So, I have no reason to cast any doubt that your surgeon is not concerned with aesthetics.

[djsbelgium]

OK. Thanks for the better organization.

What I can say is that your recent self photo (first in series) and your ceph do look consistent with the ceph displacement plan your surgeon made for you as to the proposed  changes which are of course preliminary and ultimately will be contingent on the extent of what the braces will do to prepare you.

I think it also needs to be pointed out that a doc who DOES use the Arnett system (which you correctly point out is that of the ceph displacement diagram) IS using a type of analysis that is BASED on maximizing aesthetics. As to the chin, with SLIDING genio, that would advance out more but it would ALSO tend to SHORTEN the chin which would explain why your doc did not suggest chin advancement. Sliding genios that both advance out chin and vertically shorten chin are not suggested for people with the 'deep bites' because they usually have 'short chin' with that. So, I have no reason to cast any doubt that your surgeon is not concerned with aesthetics.

Thank you for the reply. It's rather his clinic that uses the Arnett system but yes same thing. Is there any source where i can educate my self on the Arnett Gunnson analysis? I couldn't find any.

Could you elaborate what you mean by a short chin? I find that i have a strong chin but i'm not sure if the chin should meet at the lips or at the brow ridge. I've heard both.

Would you recommend any aesthetic work to look more like i did before mouthbreathing? Like cheekbone work or gonial angle implants

[kavan]

Thank you for the reply. It's rather his clinic that uses the Arnett system but yes same thing. Is there any source where i can educate my self on the Arnett Gunnson analysis? I couldn't find any.

Could you elaborate what you mean by a short chin? I find that i have a strong chin but i'm not sure if the chin should meet at the lips or at the brow ridge. I've heard both.

Would you recommend any aesthetic work to look more like i did before mouthbreathing? Like cheekbone work or gonial angle implants

Here's a link with some basic coverage of Arnett analysis.
https://www.sciencedirect.com/science/article/pii/S2395921516300575
It shows someone with pretty good proportions and shows that the chin is BEHIND a vertical dropped from the lower lip.

I would not concern myself with cheek bone work or gonial implants at this point in time. In a case like yours, they are better considered at a later point in time after main maxfax work is completed.

[djsbelgium]

I would not concern myself with cheek bone work or gonial implants at this point in time. In a case like yours, they are better considered at a later point in time after main maxfax work is completed.

Wouldn't bimax advancement reduce cheekbone definition? I know cheekbones can be done during the double jaw surgery.
What exactly makes you say that in terms of my case?

Thanks for the Arnett link

[kavan]

Wouldn't bimax advancement reduce cheekbone definition? I know cheekbones can be done during the double jaw surgery.
What exactly makes you say that in terms of my case?

Thanks for the Arnett link

TECHNICALLY, NO.  In terms of how the cheek bones might look RELATIVE to a Lefort 1 advancement (eg. they might look  less pronounced RELATIVE to an area below them being brought forward), how that might look to YOU, can't be answered. Hence my suggestion to WAIT till a later time to evaluate whether or not you want cheek augmentation.

ETA: I don't answer questions concerning areas (such as cheek bones) that I CAN'T see on your PRESENT photos. No full frontal photo WITH EYES showing and/or no 3/4 (oblique view) where cheek curve is shown= no specific feedback as to cheek bones other than to tell you they can be addressed later down the line.

[april]

I think you look pretty good in your pic.

About the plan I think your chin is within the norms according to Arnett's analysis.
For males, soft tissue pogonion should sit -3.5 (+/- 1.8 ) from the True Vertical Line. In your plan, yours is -5 from the TVL, so it's still considered within the range.

I don't know the types of different genios and what they can do, but you don't want the curve between your chin and lip to become too deep.

It's obvs all gonna change after ortho though. I think your bite still looks deep in his plan...

[djsbelgium]

I think you look pretty good in your pic.

About the plan I think your chin is within the norms according to Arnett's analysis.
For males, soft tissue pogonion should sit -3.5 (+/- 1.8 ) from the True Vertical Line. In your plan, yours is -5 from the TVL, so it's still considered within the range.

I don't know the types of different genios and what they can do, but you don't want the curve between your chin and lip to become too deep.

It's obvs all gonna change after ortho though. I think your bite still looks deep in his plan...

What causes the 'chin curve' to become deep? I always wondered

Yes the plan was made based on the X-Ray where i didn't have braces. My teeth were angled inwards, a lot has changed already after a month of braces.

[Post bimax]

What causes the 'chin curve' to become deep? I always wondered

Yes the plan was made based on the X-Ray where i didn't have braces. My teeth were angled inwards, a lot has changed already after a month of braces.

The visible 'chin curve' is the called the mentolabial fold.  As I understand it, the mentolabial angle (angle created by the intersection of the pogonion to crease and lower lip to crease) and chin projection are the primary influences on mentolabial fold appearance.  A more 'acute' angle will create a more obvious fold, which will deepen with horizontal projection.  This (I think) is why Kavan suggested avoiding a genioplasty which would shorten the chin.  A more obtuse angle will soften the fold but lengthen the face.