opinion for my next operation

[Anna]

Hello,

I have the following problems:

- gummy smile
- receding chin
- asymmetry of the mandible (right ramus shorter than the left, visible on the panoramic scanner)
- visible nasal deviation (asymmetrical nose that goes to the side), it causes me great discomfort to breathe through my nose (glossoptosis): I sleep on my stomach
- tongue that touches the teeth
- cracking on the right side of the mandible when I yawn or eat for example

The pics are here: https://imgur.com/a/S2NIjgz

I do this operation for both functional and aesthetic reasons, I often have unpleasant remarks on this part of my face which influences my self-confidence.
My orthodontist will have my braces fitted at the end of this month of January.

I don't just want to fix my functional problems, I want to look good, pretty. So, I would like to have your opinion on my case. I have seen several surgeons (France) who have all offered me the same thing: bi-max + genioplasty + titanium prostheses for the symmetry of the angles + septoplasty.

However, I find that my middle third is quite flat, I always look tired with big circles (see photo).
Is it possible to perform a lefort 1 high or a lefort 2 to correct this, despite my gummy smile?

I also want to know what this girl did as an operation to make her result so good : https://imgur.com/a/rgkbo7M

Thank you in advance for your advice!
Have a good day

[GJ]

Do you have a surgical plan to share?

This looks like a classic case for counter-clockwise rotation. Hopefully they are planning to do that. I see ccw arrows on the x-ray - who drew those?

[kavan]

Your photos suggest counter clockwise rotation (CCW-r) of the maxilla via impaction along with bimax advancement in addition to genioplasty. BOTH form (aesthetics) and function stand to be improved by that in addition to addressing asymmetry to the jaw angle area offered to you.

Septoplasty would tend to improve function. Final FORM of the nose (aesthetics) could be addressed in a separate surgery by surgeon who does a lot of rhinos and is good at doing them. That would depend on whether or not the displacements of the bimax surgery kick up a form that is 'prettier enough' for your desires.

Likewise to the area of the upper midface; the BONES right BELOW the EYE which don't change with the bimax surgery. Final form as in 'prettier enough' could be pursued in a second procedure. That is say, the under eye area would be a SEPARATE PURSUIT after the outcome of the surgery offered to you presently. It is not something for me to elaborate on here given it wasn't offered to you and is not part of the Lefort 1 area.

Included is a diagram of the 3 types of Leforts. On it, I've ovaled in RED, the bone support UNDER THE EYES. Targeting that basic isolated area is a separate pursuit. It isn't part of a Lefort 1, nor is it a Lefort 2. It's an isolated area cut out from a Lefort 3.

What somebody else did can't be answered here as to be directly applicable to anyone else's UNIQUE situation. My GUESS would be she had CCW-r, possibly impaction with bimax advancement along with genioplasty. My GUESS is NOT a definitive answer for what she had. Nor is it a prediction that having the GENERAL surgery she MIGHT have had would produce the same outcomes as hers for another person. Everyone has UNIQUE measures for their START POINT that factor into the OUTCOME (end point).

[Anna]

Do you have a surgical plan to share?

This looks like a classic case for counter-clockwise rotation. Hopefully they are planning to do that. I see ccw arrows on the x-ray - who drew those?

I don't have surgical plan for the moment.
It's the surgeon who drew these arrows to illustrate the operation he plans to perform!

[Anna]

Your photos suggest counter clockwise rotation (CCW-r) of the maxilla via impaction along with bimax advancement in addition to genioplasty. BOTH form (aesthetics) and function stand to be improved by that in addition to addressing asymmetry to the jaw angle area offered to you.

Septoplasty would tend to improve function. Final FORM of the nose (aesthetics) could be addressed in a separate surgery by surgeon who does a lot of rhinos and is good at doing them. That would depend on whether or not the displacements of the bimax surgery kick up a form that is 'prettier enough' for your desires.

Likewise to the area of the upper midface; the BONES right BELOW the EYE which don't change with the bimax surgery. Final form as in 'prettier enough' could be pursued in a second procedure. That is say, the under eye area would be a SEPARATE PURSUIT after the outcome of the surgery offered to you presently. It is not something for me to elaborate on here given it wasn't offered to you and is not part of the Lefort 1 area.

Included is a diagram of the 3 types of Leforts. On it, I've ovaled in RED, the bone support UNDER THE EYES. Targeting that basic isolated area is a separate pursuit. It isn't part of a Lefort 1, nor is it a Lefort 2. It's an isolated area cut out from a Lefort 3.

What somebody else did can't be answered here as to be directly applicable to anyone else's UNIQUE situation. My GUESS would be she had CCW-r, possibly impaction with bimax advancement along with genioplasty. My GUESS is NOT a definitive answer for what she had. Nor is it a prediction that having the GENERAL surgery she MIGHT have had would produce the same outcomes as hers for another person. Everyone has UNIQUE measures for their START POINT that factor into the OUTCOME (end point).

Thanks for your answer, I will talk to my surgeon about the area under the eyes tomorrow.

[GJ]

It's the surgeon who drew these arrows to illustrate the operation he plans to perform!

Then that looks to be the correct general idea.

When you get an actual plan, come back and share it.

[Anna]

Hello,

Hope you are doing well, here are some new 3d pictures here : https://imgur.com/a/ApLLgxN
For the mandibular angles, the surgeon offers me orthodondic cement instead of the titanium plates, what do you think of that ?
He also told me that the cheekbone prostheses could not be put on in one operation, yet he told me it was ok at the previous appointment.

Do you have a surgical plan to share?

This looks like a classic case for counter-clockwise rotation. Hopefully they are planning to do that. I see ccw arrows on the x-ray - who drew those?

Also, where can I find the surgical plan ? I have 2 CDs issued by the radiologist.

Have a good day !