Author Topic: How can I fix my face  (Read 6173 times)

TheGerman

  • Newbie
  • *
  • Posts: 28
  • Karma: 1
How can I fix my face
« on: June 19, 2022, 08:16:16 AM »
I'm rather new to osteotomies/maxillofacial surgeries but I know I probably need some form of ccwr trimax. I believe I was made way uglier by the treatment plan of my orthodontist. I had braces from 14 to 18 years. They extracted all of my canine teeth and I also had to wear elastics. I need to know how I can fix my ruined occlusion and my facial aesthetics. Most important questions in my opinion are:

-Do I need decompensation before jaw surgery?
-Do I need some form of jaw widening either by ramus widening or with jaw angle implants later?
-What movements are the right ones for my case?
-Is the damage done by my ortho reversible?
-Besides ccwr trimax, do I need anything else to fix my skull/face? General feedback to my skull would be nice
-What surgeon would you recommend for my case?

I have pics of my face (sadly low quality) and pics of my cbct scan:

https://imgur.com/a/un94GGc (cbct)

https://imgur.com/a/5SKNyZo (face)
« Last Edit: June 19, 2022, 08:32:12 AM by TheGerman »

Tomasjohn

  • Private
  • Full Member
  • *****
  • Posts: 113
  • Karma: 23
Re: How can I fix my face
« Reply #1 on: June 19, 2022, 08:34:04 AM »
The only thing I can say: It seems you have a rather big nasolabial angle. If you move the upper jaw forward the angle could get more obtuse.

TheGerman

  • Newbie
  • *
  • Posts: 28
  • Karma: 1
Re: How can I fix my face
« Reply #2 on: June 19, 2022, 08:39:10 AM »
The only thing I can say: It seems you have a rather big nasolabial angle. If you move the upper jaw forward the angle could get more obtuse.
So you mean it would make it's appearance even worse? But wouldn't ccw rotation and maybe proclining my upper incisors help with the bad angle?

kavan

  • Global Moderator
  • Hero Member
  • *****
  • Posts: 3966
  • Karma: 423
Re: How can I fix my face
« Reply #3 on: June 19, 2022, 01:14:34 PM »
Main issue here is that you have a prominent nasal spine (ANS) which is the thing that contributes to the appearance of your lower jaw looking relatively recessed compared to your upper jaw. So, ANS would need to be cutdown/reduced. That would resolve to what's called a DEPROJECTION RHINOPLASTY. So, if you got that, your lower jaw area would look MORE in balance with the upper jaw.

With the PROMINENT ANS as it is now, you would look TERRIBLE if the upper jaw was advanced BUT the ANS was not reduced in the process. So IF you got a double jaw surgery and ALSO IF the upper jaw needed to be advanced to 'mesh' with a lower jaw advancement, you would need to have a surgeon who could DEPROJECT the ANS as part of the process.

Most jaw surgeries for people who have had prior ortho (or even those who have not), the bite  needs to be DECOMPENSATED. But INSTEAD of using that term, let's keep it SIMPLE and just say it's more likely than not that the teeth will need to be put in BRACES to prepare for the displacements of the surgery.

Aesthetically speaking, you look like a candidate for SINGLE lower jaw surgery and deprojection rhinoplasty. It's also looking like if you found a good rhino surgeon to perform the deprojection rhino and did that first, your lower jaw would look LESS recessive than it does now when compared to the prominent ANS that makes your upper jaw look too PROTRUSIVE, in which case, you could re-evaluate the jaw balance and perhaps decide not to get a single lower jaw advancement at all.

In closing your PROMINENT ANS is what's throwing off aesthetic jaw to jaw balance and contributing to the LOOK/appearance of your maxila area looking TOO protrusive which in turn makes your lower jaw look retrusive via RELATIVE COMPARISON.
Please. No PMs for private advice. Board issues only.

kavan

  • Global Moderator
  • Hero Member
  • *****
  • Posts: 3966
  • Karma: 423
Re: How can I fix my face
« Reply #4 on: June 19, 2022, 01:21:33 PM »
So you mean it would make it's appearance even worse? But wouldn't ccw rotation and maybe proclining my upper incisors help with the bad angle?

YES, you would look worse. Because your 'overly obtuse' nasiolabial angle is due to your overly protrusive anterior nasal spine (ANS). I've addressed that in my recent post to you. Tomas john is CORRECT. Advancement of the upper jaw would make you look WORSE and for it not to you would need REDUCTION of the ANS.
Please. No PMs for private advice. Board issues only.

TheGerman

  • Newbie
  • *
  • Posts: 28
  • Karma: 1
Re: How can I fix my face
« Reply #5 on: June 19, 2022, 01:35:57 PM »
Main issue here is that you have a prominent nasal spine (ANS) which is the thing that contributes to the appearance of your lower jaw looking relatively recessed compared to your upper jaw. So, ANS would need to be cutdown/reduced. That would resolve to what's called a DEPROJECTION RHINOPLASTY. So, if you got that, your lower jaw area would look MORE in balance with the upper jaw.

With the PROMINENT ANS as it is now, you would look TERRIBLE if the upper jaw was advanced BUT the ANS was not reduced in the process. So IF you got a double jaw surgery and ALSO IF the upper jaw needed to be advanced to 'mesh' with a lower jaw advancement, you would need to have a surgeon who could DEPROJECT the ANS as part of the process.

Most jaw surgeries for people who have had prior ortho (or even those who have not), the bite  needs to be DECOMPENSATED. But INSTEAD of using that term, let's keep it SIMPLE and just say it's more likely than not that the teeth will need to be put in BRACES to prepare for the displacements of the surgery.

Aesthetically speaking, you look like a candidate for SINGLE lower jaw surgery and deprojection rhinoplasty. It's also looking like if you found a good rhino surgeon to perform the deprojection rhino and did that first, your lower jaw would look LESS recessive than it does now when compared to the prominent ANS that makes your upper jaw look too PROTRUSIVE, in which case, you could re-evaluate the jaw balance and perhaps decide not to get a single lower jaw advancement at all.

In closing your PROMINENT ANS is what's throwing off aesthetic jaw to jaw balance and contributing to the LOOK/appearance of your maxila area looking TOO protrusive which in turn makes your lower jaw look retrusive via RELATIVE COMPARISON.

Interesting insight. I have never read too much about the ANS but always felt like my ANS was in the normal range. However I've always been somewhat irritated by the fact that my nose base is infront of my browridge even though my mandible and also my maxilla look kinda recessed. For the TRIMAX surgery the Dr. I consulted with said he wouldn't do any advancement on the upper jaw, only rotation, which would result in an "advancement" of the ANS by about 2mm. Other movements would be 8mm BSSO and 6mm wedge cut genio + 4-5mm ramus widening on each side. Is that a way of fixing things? Because I don't think there are many surgeons that I want working on my ANS..seems risky.

I think my biggist issue is downward growth tbh.

Here is the plan the Dr. proposed:
https://imgur.com/a/wkq0B2c

kavan

  • Global Moderator
  • Hero Member
  • *****
  • Posts: 3966
  • Karma: 423
Re: How can I fix my face
« Reply #6 on: June 19, 2022, 05:41:38 PM »
your imgur acccount makes people sign in.  if your nose base is in front as you say, THAT means prominent ANS. it also shows on your bone scan model. again, advancement of the ANS will make you look WORSE. that is the salient info.
Please. No PMs for private advice. Board issues only.

TheGerman

  • Newbie
  • *
  • Posts: 28
  • Karma: 1
Re: How can I fix my face
« Reply #7 on: June 20, 2022, 03:34:48 AM »
your imgur acccount makes people sign in.  if your nose base is in front as you say, THAT means prominent ANS. it also shows on your bone scan model. again, advancement of the ANS will make you look WORSE. that is the salient info.
I don't know how to change the signing in stuff.

But trimax without advancing upper jaw would be a solution right?

kavan

  • Global Moderator
  • Hero Member
  • *****
  • Posts: 3966
  • Karma: 423
Re: How can I fix my face
« Reply #8 on: June 20, 2022, 12:32:32 PM »
I don't know how to change the signing in stuff.

But trimax without advancing upper jaw would be a solution right?

Communication here is not working out for the following reasons:

1: I've given you my advice already.

2: I will not be communicating in terms of 'TRIMAX' because the word implies someone has 3 (three) jaws and not 2 (two).

3: My explanations about the ANS being a key issue were sufficient enough for someone of average intelligence/comprehension ability to FIGURE OUT on their own that a proposed CCW rotation at the upper jaw involving the ANS projecting out FURTHER (in a circumstance where the doctor made CLEAR a CCW rotation at maxilla would project out the ANS more) would make someone with a protrusive ANS look WORSE.

That said, your last (and FINAL) question/conclusion to me suggests inability to 'digest' very straight forward information and has resulted in my electing to DISCONTINUE further advice.
Please. No PMs for private advice. Board issues only.

TheGerman

  • Newbie
  • *
  • Posts: 28
  • Karma: 1
Re: How can I fix my face
« Reply #9 on: June 20, 2022, 02:45:19 PM »
Communication here is not working out for the following reasons:

1: I've given you my advice already.

2: I will not be communicating in terms of 'TRIMAX' because the word implies someone has 3 (three) jaws and not 2 (two).

3: My explanations about the ANS being a key issue were sufficient enough for someone of average intelligence/comprehension ability to FIGURE OUT on their own that a proposed CCW rotation at the upper jaw involving the ANS projecting out FURTHER (in a circumstance where the doctor made CLEAR a CCW rotation at maxilla would project out the ANS more) would make someone with a protrusive ANS look WORSE.

That said, your last (and FINAL) question/conclusion to me suggests inability to 'digest' very straight forward information and has resulted in my electing to DISCONTINUE further advice.
Trimax is a normal term for bimax + genio? Also no need to be so unfriendly since I can't just shave off my ANS or anything. I have seen alot of cbcts and many caucasians hat similar ANS projection like I did

Tomasjohn

  • Private
  • Full Member
  • *****
  • Posts: 113
  • Karma: 23
Re: How can I fix my face
« Reply #10 on: June 21, 2022, 06:43:39 AM »
Trimax is a normal term for bimax + genio? Also no need to be so unfriendly since I can't just shave off my ANS or anything. I have seen alot of cbcts and many caucasians hat similar ANS projection like I did

Probably a normal term in the looksmax online community, correct?

PapiMew

  • Newbie
  • *
  • Posts: 4
  • Karma: 0
Re: How can I fix my face
« Reply #11 on: June 21, 2022, 06:53:42 AM »
Probably a normal term in the looksmax online community, correct?

I’ve seen a multitude of surgeons use the term “Trimax”

What’s your point?

Tomasjohn

  • Private
  • Full Member
  • *****
  • Posts: 113
  • Karma: 23
Re: How can I fix my face
« Reply #12 on: June 22, 2022, 05:05:08 AM »
I’ve seen a multitude of surgeons use the term “Trimax”

What’s your point?

I am curious where the term is coming from. When i looked it up online it lead me to those sites.

Its always interesting to see how the internet influences those things.

kavan

  • Global Moderator
  • Hero Member
  • *****
  • Posts: 3966
  • Karma: 423
Re: How can I fix my face
« Reply #13 on: June 22, 2022, 02:46:18 PM »
I am curious where the term is coming from. When i looked it up online it lead me to those sites.

Its always interesting to see how the internet influences those things.

It's a marketing term used by some doctor in Europe. I guess the TARGET market would be those who think they have 3 jaws or might not realize the extra jaw of the 3 would be the chin.
Please. No PMs for private advice. Board issues only.

TheGerman

  • Newbie
  • *
  • Posts: 28
  • Karma: 1
Re: How can I fix my face
« Reply #14 on: June 24, 2022, 10:38:01 AM »
Probably a normal term in the looksmax online community, correct?
I saw it on these kind of forums too but first heard of it from Doctors