Is it a BIMAX Rotation Advancement that I need? Help. Pics included.

[toman1998]

Hello,

I am 22 years old from the UK, and I have a weak lower half of the face, my chin and jaw both appear weak, which makes my nose look even bigger than it already is and because of this I hate my appearance and it makes me appear much younger than I am.

I originally considered a sliding genioplasty but I don’t think this would help as it seems my whole lower half of the face is weak. I was then thinking I would probably need a bimax surgery to bring both my jaws forward, although I don’t know how I could do this as my philtrum between my nose and upper lip is really short so fear my teeth would protrude.

I’ve seen online (especially at the Sailer Klinik, although unsure how reliable it is) that a BIMAX Rotation Advancement would probably be the best thing for me as you can get more extension this way and it doesn’t bring the upper jaw forward as much (I think)? I’m still confused about this though so thought I'd come on here to ask questions.

I have a normal bite as I had braces so I don’t have any dental issues and unsure if I have sleep apnea but I do get shortness of breath both through my nose and mouth, although not enough for it to be for health reasons. I am from the UK so because this would be for cosmetic reasons I was wondering what the average price for BIMAX Rotation Surgery is and where is good to do it (abroad as well)? Also, am I right in thinking that with this procedure I would need work done on my nose to keep it in balance?

I would really appreciate other peoples opinions on what I should consider and what would be best, as I feel very in the dark about this and it’s on my mind a lot. I’ve attached a link with the photos of my profile now and then how I wish it could look.

I would really appreciate your help, thank you so much.

https://imgur.com/a/lxqEMrv

[kavan]

You have a prominent Anterior Nasal Spine and look like a candidate for a deprojection rhino.

See this thread: http://jawsurgeryforums.com/index.php/topic,8000.15.html 

Check out my feedback starting with reply #13 and do look at the 'back and forth' within that thread.

You have a very SIMILAR issue to the patient in that particular string .

[toman1998]

You have a prominent Anterior Nasal Spine and look like a candidate for a deprojection rhino.

See this thread: http://jawsurgeryforums.com/index.php/topic,8000.15.html 

Check out my feedback starting with reply #13 and do look at the 'back and forth' within that thread.

You have a very SIMILAR issue to the patient in that particular string .

Yes I've noticed I do have that, thanks for your reply, I've looked into that thread and agree we have similar issues. So would you think a BIMAX Rotation advancement alongside an ANS Nose Surgery would be possible for me then, to achieve similar results as in my edited photo?
Also still a bit unclear how the rotation advancement works: how can they extent the lower jaw so far forward without bringing the upper jaw as forward?

Thanks again!

[GJ]

The 2nd photo doesn't look nearly as obvious as the 1st. Are you changing your head angle?

Usually the worst shot is more accurate, so I'll assume photo 1 is reality. If that's the case, it does look like you could benefit from CCW rotation. Your case doesn't look drastic to me. You seem to have good features and skin, just a bit of recession. I'm not sure it's worth it. It depends how much you care that it makes your nose out of balance, and whether you'd rather reduce the nose/bring out the chin or go through the whole shebang of jaw surgery. Cephs would help if you have any.

[kavan]

Yes I've noticed I do have that, thanks for your reply, I've looked into that thread and agree we have similar issues. So would you think a BIMAX Rotation advancement alongside an ANS Nose Surgery would be possible for me then, to achieve similar results as in my edited photo?
Also still a bit unclear how the rotation advancement works: how can they extent the lower jaw so far forward without bringing the upper jaw as forward?

Thanks again!

Firstly, I decline to analyze your morph in terms of whether or not the surgery will achieve it's outcome. That is especially so when someone uses an entirely different photo for changes. what I will convey about logistics of morphing is that:

a: A morph is called a 'morph' and not an 'after'

b: A morph is a change to to the ORIGINAL photo and placed SIDE BY SIDE of it.

c: A morph is a 'vision' of a desired change but not really a prediction of a surgical outcome.

As to your other questions:

Based on the thread of the person with similarities to you, within it, I don't advocate an ANS nose surgery be done along side of the bimax. Instead, IMO, unlike most people who are better off getting the maxfax surgery PRIOR to a rhino, I'm of the opinion that those with a very prominent ANS consider having the rhino first. It is because other rhinoplasty adjustments would need to be done with a cut down of the ANS and that sort of thing is more in the venue of a good 'nose guy' than a maxfax. That's my opinion. It's not cemented in stone. I don't deny the existence of SOME maxfax doctors being good at BOTH bimax and rhinos. But can't confirm the existence of most or all maxfax docs being good at both.

As to how they get a lot of lower jaw advancement via rotation via a BIMAX with CCW rotation where the CCW rotation is that of posterior downgraft: The BASIC concept of this is GEOMETRICAL. It's based on rotating a TRIANGLE around a fixed point. For example, a triangle of ABC rotated around fixed point; 'A' will have it that vertex; 'B' will go DOWNWARD and vertex; 'C' will go OUTWARD (forward). Here's a link to a diagram showing that basic concept.

http://jawsurgeryforums.com/index.php/topic,7883.0.html

[Post bimax]

The 2nd photo doesn't look nearly as obvious as the 1st. Are you changing your head angle?

Usually the worst shot is more accurate, so I'll assume photo 1 is reality. If that's the case, it does look like you could benefit from CCW rotation. Your case doesn't look drastic to me. You seem to have good features and skin, just a bit of recession. I'm not sure it's worth it. It depends how much you care that it makes your nose out of balance, and whether you'd rather reduce the nose/bring out the chin or go through the whole shebang of jaw surgery. Cephs would help if you have any.

The 2nd photo is a morph

[toman1998]

The 2nd photo doesn't look nearly as obvious as the 1st. Are you changing your head angle?

Usually the worst shot is more accurate, so I'll assume photo 1 is reality. If that's the case, it does look like you could benefit from CCW rotation. Your case doesn't look drastic to me. You seem to have good features and skin, just a bit of recession. I'm not sure it's worth it. It depends how much you care that it makes your nose out of balance, and whether you'd rather reduce the nose/bring out the chin or go through the whole shebang of jaw surgery. Cephs would help if you have any.

Hi, the second photo is an edited photo of how I would like my side profile to look around about. I'm really set on it getting it done, but definitely need to do more research on it before I make a definite decision. Do you know what an estimate amount a CCW rotation costs? I can't seem to find much from google.

Also sorry if this is a stupid question, what are Cephs?
Thanks for your help.

[toman1998]

Firstly, I decline to analyze your morph in terms of whether or not the surgery will achieve it's outcome. That is especially so when someone uses an entirely different photo for changes. what I will convey about logistics of morphing is that:

a: A morph is called a 'morph' and not an 'after'

b: A morph is a change to to the ORIGINAL photo and placed SIDE BY SIDE of it.

c: A morph is a 'vision' of a desired change but not really a prediction of a surgical outcome.

As to your other questions:

Based on the thread of the person with similarities to you, within it, I don't advocate an ANS nose surgery be done along side of the bimax. Instead, IMO, unlike most people who are better off getting the maxfax surgery PRIOR to a rhino, I'm of the opinion that those with a very prominent ANS consider having the rhino first. It is because other rhinoplasty adjustments would need to be done with a cut down of the ANS and that sort of thing is more in the venue of a good 'nose guy' than a maxfax. That's my opinion. It's not cemented in stone. I don't deny the existence of SOME maxfax doctors being good at BOTH bimax and rhinos. But can't confirm the existence of most or all maxfax docs being good at both.

As to how they get a lot of lower jaw advancement via rotation via a BIMAX with CCW rotation where the CCW rotation is that of posterior downgraft: The BASIC concept of this is GEOMETRICAL. It's based on rotating a TRIANGLE around a fixed point. For example, a triangle of ABC rotated around fixed point; 'A' will have it that vertex; 'B' will go DOWNWARD and vertex; 'C' will go OUTWARD (forward). Here's a link to a diagram showing that basic concept.

http://jawsurgeryforums.com/index.php/topic,7883.0.html

This is really helpful, thank you so much!

[Boxer Dog]

Also sorry if this is a stupid question, what are Cephs?

A Ceph is an X-Ray of your jaws.