Are there surgeons who will do an upper impaction instead of a downgraft?

[instajaw]

Hi everyone,

I'm starting the hunt to find the right surgeon and I want one that will do an upper impaction for my CCW jaw surgery instead of a posterior downgraft. I've heard that Wolfard loves doing posterior downgrafts, so I'm stearing clear of him. Are there any surgeons that have a preference for upper impactions? I'm trying to get a shorter midface.

[Dogmatix]

If you want to do CCW by upper impaction, you would have to do anterior impaction. This will decrease your upper teeth show, significantly if you want to achieve any noticeable rotation. Anterior impaction is a common procedure in case you have gummy smile and I've never heard that surgeons avoid doing it. But it's a procedure reserved to those with a significant gummy smile, you can imagine how it would look to impact a lot if you already have normal teeth show. Sometimes the rotation can be achieved by a combination of posterior down grafting and anterior impaction. All the good surgeons have the amount of teeth show in mind when planning a surgery and control this with how they displace the maxilla. Chasing a surgeon that will do it by anterior impaction, when the good surgeons don't want to, doesn't seem like a good idea.

[GJ]

If you want to do CCW by upper impaction, you would have to do anterior impaction. This will decrease your upper teeth show, significantly if you want to achieve any noticeable rotation. Anterior impaction is a common procedure in case you have gummy smile and I've never heard that surgeons avoid doing it. But it's a procedure reserved to those with a significant gummy smile, you can imagine how it would look to impact a lot if you already have normal teeth show. Sometimes the rotation can be achieved by a combination of posterior down grafting and anterior impaction. All the good surgeons have the amount of teeth show in mind when planning a surgery and control this with how they displace the maxilla. Chasing a surgeon that will do it by anterior impaction, when the good surgeons don't want to, doesn't seem like a good idea.

This is good advice.

And all cuts have 1mm impaction just from the bone saw cut. So you're going to get that no matter what.

OP, do you have a severe gummy smile?

[Dogmatix]

This is good advice.

And all cuts have 1mm impaction just from the bone saw cut. So you're going to get that no matter what.

OP, do you have a severe gummy smile?

One should also consider that posterior downgrafting is considered a hard procedure that not all surgeons do, while impaction is the easy procedure that everyone does. So specifically chosing surgeons that say that they won't do posterior downgrafting may limit the selection and exclude the good surgeons and you end up with the bad ones. You want a surgeon with a big toolbox that can handle both and chose what is most suitable for you.

[TWGOAT]

Hi everyone,

I'm starting the hunt to find the right surgeon and I want one that will do an upper impaction for my CCW jaw surgery instead of a posterior downgraft. I've heard that Wolfard loves doing posterior downgrafts, so I'm stearing clear of him. Are there any surgeons that have a preference for upper impactions? I'm trying to get a shorter midface.

Steer clear of Wolford ? lmao

If you want someone who does CCW its him, of course he does impaction too.

The percentage of surgeons able to posterior downgraft is incredibly lower than the ones doing impaction

[kavan]

If the excess length to the face is between the root of the nose (near the glabella) and the base of the nose, then there is no shortening procedure when the excess is found between those 2 areas. So, if excess is found between root of nose and base of nose which is the 'middle 1/3rd' of the face called the MIDFACE, then NO shortening procedure for that part.

Only if the excess length to the face is to the 'lower 1/3rd' of the face (from BASE of nose to base of chin) where excess to anterior maxilla is obvious culprit to excess length, (what dogmatix told you is seen by excess gum show), then YES, that area can be shortened.

No idea where your particular excess length is but just to say, the MIDFACE area is the area between the root of the nose (near glabella) and the base of the nose. So, impaction is not going to shorten that particular area.

[Gadwins]

Late for this topic, but still: In germany all surgeons will do an impaction even if a downgraft would be better. I don't know a single surgeon in germany who do any sort of grafting at the upper jaw. Even who perform a chin wing won't do any sort of downgraft of the upper jaw.