BIMAX HAS LIMITS IN MOVEMENT

[normie_joe]

I saw this woman posted and folks were like "she's still recessed, she should be advanced more and what not."

Fair enough.

But where is the surgeon supposed to get that movement from?

You can't change physics.

There's only two ways she can get more movement:

1) Pre-molar extractions from the mandible

2) More lefort movement that allows more mandible movement, which will ruin her midface.

Learn how the physics of bimax works before suggesting things like a 3cm bsso.

 

[Iooksmax]

should have gotten monobloc + bsso

 

[Lefor3Laser]

View attachment 3463104

I saw this woman posted and folks were like "she's still recessed, she should be advanced more and what not."

Fair enough.

But where is the surgeon supposed to get that movement from?

You can't change physics.

There's only two ways she can get more movement:

1) Pre-molar extractions from the mandible

2) More lefort movement that allows more mandible movement, which will ruin her midface.

Learn how the physics of bimax works before suggesting things like a 3cm bsso.

Downgrowth can't be fixed easily, her ramus was already small, pre molar extraction isn't always required it depends on the cut.

I agree on the le fort one though, getting alot of forward growth will dogmax you, it's ideal to just get your chin and lips aligned and fix the down growth looks of the mandible with implants.

Plus that her surgeon didn't make her occlusal plane 0.

 

[iseeblue9]

she can but it will masculinize her face which she doesn’t want obv

 

[normie_joe]

Downgrowth can't be fixed easily, her ramus was already small, pre molar extraction isn't always required it depends on the cut.

You are confusing pre molar with wisdom teeth.

Plus that her surgeon didn't make her occlusal plane 0.

Occlusal plane != mandibular angle

Your mandible can be down grown and still have a flat occlusal plane.

 

[LilJojo]

View attachment 3463104

I saw this woman posted and folks were like "she's still recessed, she should be advanced more and what not."

Fair enough.

But where is the surgeon supposed to get that movement from?

You can't change physics.

There's only two ways she can get more movement:

1) Pre-molar extractions from the mandible

2) More lefort movement that allows more mandible movement, which will ruin her midface.

Learn how the physics of bimax works before suggesting things like a 3cm bsso.

No shit you can’t become a monkey

 

[Lefor3Laser]

You are confusing pre molar with wisdom teeth.





Occlusal plane != mandibular angle

Your mandible can be down grown and still have a flat occlusal plane.

Mb your right, about the pre molar.

But aren't they related?, I've read somewhere that they are kind of related.

 

[BecomingHuman]

It's just Ramieri style

 

[normie_joe]

Mb your right, about the pre molar.

But aren't they related?, I've read somewhere that they are kind of related.

They are, but one does not directly imply the other.

 

[BecomingHuman]

Also maybe other surgeons cherry pick their patients. So even when they have these cases they post only the best ones. So you would never see case like this on Rafaini insta.

 

[BecomingHuman]

Look at this:

Left is before, right is after. I've seen a lot of similar cases on underbites. Don't tell me about bimax limitations.

 

[BecomingHuman]

Ramieri errors on the underadvancement side (aesthetic risks).

Alfaro errors on the overadvacement side (aesthetic risks + extra health risks).

 

[normie_joe]

Look at this:

Left is before, right is after. I've seen a lot of similar cases on underbites. Don't tell me about bimax limitations.

View attachment 3463167

She's tilting her head up in the first photo.

Looks more class 2 than 3 tbh.

Lefort was overdone.

 

[normie_joe]

Ramieri errors on the underadvancement side (aesthetic risks).

It's also safety and functional as well.

Alfaro errors on the overadvacement side (aesthetic risks + extra health risks).

Which is why he is dogshit.

Before

After

This guy looks like a horse and can't close his lips.

 

[Lefor3Laser]

It's also safety and functional as well.




Which is why he is dogshit.

Before

View attachment 3463179

After

View attachment 3463180View attachment 3463181View attachment 3463182

This guy looks like a horse and can't close his lips.

Brutal botch, he had good proportions before compared to his in the after.

 

[cucklek]

alfaro is the only surgeon that would „fix“ her side by overadvancing but for what price? tmj problems and high risk of relapse

 

[normie_joe]

Brutal botch, he had good proportions before compared to his in the after.

This is why I advocate for someone like Ramieri.

Sure some maybe like "yeah I wish I got 20% more movement" but he leaves you looking normal and functional.

 

[Lefor3Laser]

alfaro is the only surgeon that would „fix“ her side by overadvancing but for what price? tmj problems and high risk of relapse

I think if he also did jaw widening with the bimax it would be over for the pacient, I've read that many people whom got jaw widening had condyle problems.

 

[Lefor3Laser]

This is why I advocate for someone like Ramieri.

Sure some maybe like "yeah I wish I got 20% more movement" but he leaves you looking normal and functional.

I mean, just find a sane surgeon who knows what he is doing, you'll also need to know what you are doing tho, many people who get the surgeries don't have any idea about it.

 

[Anchor_Ship]

She doesn’t look recessed to me. She has no ramus

 

[normie_joe]

She doesn’t look recessed to me. She has no ramus

Her chin is behind her lower lip which makes her look recessed. IRL it's useless.

And you are right as well.

 

[Anchor_Ship]

Her chin is still not in line with her glabella, but IRL it's literally useless.

If you advance it further the mentolabial will be off

 

[normie_joe]

If you advance it further the mentolabial will be off

Yeah, you have rotate the jaws but again, you can't defy physics.

 

[Anchor_Ship]

Mb your right, about the pre molar.

But aren't they related?, I've read somewhere that they are kind of related.

They arent the same. I got all wisdom and premolar removed. It’s for decompensation purposes to remove premolar

 

[Lefor3Laser]

They arent the same. I got all wisdom and premolar removed. It’s for decompensation purposes to remove premolar

Yeah ik, was talking about the mandibular plane and occlusal plane at the end.

 

[Snicket]

View attachment 3463104

I saw this woman posted and folks were like "she's still recessed, she should be advanced more and what not."

Fair enough.

But where is the surgeon supposed to get that movement from?

You can't change physics.

There's only two ways she can get more movement:

1) Pre-molar extractions from the mandible

2) More lefort movement that allows more mandible movement, which will ruin her midface.

Learn how the physics of bimax works before suggesting things like a 3cm bsso.

You can only advance the upper jaw so far without the rest of the maxilla looking left behind. That’s why 5mm is usually the limit for many surgeons.

 

[normie_joe]

You can only advance the upper jaw so far without the rest of the maxilla looking left behind.

Plus destroying your nose + philtrum.

 

[Snicket]

Plus destroying your nose + philtrum.

Yep. Widening of alar base is a big one. Many LF-1 patients need post surgery rhinoplasties to fix the nose.

 

[Anchor_Ship]

Yep. Widening of alar base is a big one. Many LF-1 patients need post surgery rhinoplasties to fix the nose.

I plan on doing the same

 

[TheoRaven]

View attachment 3463104

I saw this woman posted and folks were like "she's still recessed, she should be advanced more and what not."

Fair enough.

But where is the surgeon supposed to get that movement from?

You can't change physics.

There's only two ways she can get more movement:

1) Pre-molar extractions from the mandible

2) More lefort movement that allows more mandible movement, which will ruin her midface.

Learn how the physics of bimax works before suggesting things like a 3cm bsso.

Her maxilla is fine, its actually ideally positioned now. Her major issue is her mandible, that shit is excessively underdeveloped. She has absolutely no ramus, it's completely flat from ear to chin.

Its also imo why the only really good bimax results that you'll ever see are generally class 3 malocclusion patients. And even there it entirely depends on when the recession started to develop and how severe it is.

A complete mandibular underdevelopment like you see with many class 2 patients, like her, is nearly impossible to fix unless you want to go into very experimental operation territory which very few surgeon would do.

 

[Snicket]

Her maxilla is fine, its actually ideally positioned now. Her major issue is her mandible, that shit is excessively underdeveloped. She has absolutely no ramus, it's completely flat from ear to chin.

Its also imo why the only really good bimax results that you'll ever see are generally class 3 malocclusion patients. And even there it entirely depends on when the recession started to develop and how severe it is.

A complete mandibular underdevelopment like you see with many class 2 patients, like her, is nearly impossible to fix unless you want to go into very experimental operation territory which very few surgeon would do.

I disagree with almost all of this.

You see that her upper maxilla is still recessed, even with make-up.

Class 3s are some of the worst cases because the entire maxillary complex is usually recessed. Advancing the jaws usually accentuates this without implants.

The best bimax patients are patients with short-face syndrome with average maxillary projection.
They literally just need a downgraft bimax to see great results.

 

[TheoRaven]

I disagree with almost all of this.

You see that her upper maxilla is still recessed, even with make-up.

Class 3s are some of the worst cases because the entire maxillary complex is usually recessed. Advancing the jaws usually accentuates this without implants.

The best bimax patients are patients with short-face syndrome with average maxillary projection.
They literally just need a bimax to see fantastic transformations that even many LF2/3 patients could never hope to achieve.

Purely from a projection point of view, her maxilla is ideally positioned now. The recession you see is in her cheekbones, not her maxilla.

Class 3s vary a lot. They have the worst and best results and it entirely depends on the severity of their recession. You're purely thinking of severe class 3 cases where the entire maxilla is recessed, when in reality, the vast majority of class 3 cases are mostly isolated to the nasal base and below. You don't see a lot of class 3s unlike class 2s in the general population at a glance because unless they open their mouths they look like everyone else.

Pretty much all good SFS bimax results are people without a class 2 malocclusion, but SFS usually presents with a class 2.

 

[Snicket]

Purely from a projection point of view, her maxilla is ideally positioned now. The recession you see is in her cheekbones, not her maxilla.

No. The maxilla extends all the way from the upper jaw to the middle of the eye sockets.
She clearly has infraorbital retrusion and a sunk paranasal area. The make-up and lighting make the result look better than it actually is.

Class 3s vary a lot. They have the worst and best results and it entirely depends on the severity of their recession. You're purely thinking of severe class 3 cases where the entire maxilla is recessed, when in reality, the vast majority of class 3 cases are mostly isolated to the nasal base and below. You don't see a lot of class 3s unlike class 2s in the general population at a glance because unless they open their mouths they look like everyone else.

For the vast majority of class 3s, the entire maxillary complex is underdeveloped. This usually comes with under-development of the infraoribital rims, paranasal hollowing, poor nasion projection. Most class 3s need implants to augment the upper maxilla.

Pretty much all good SFS bimax results are people without a class 2 malocclusion, but SFS usually presents with a class 2.

That was a typo,I meant to say with a class 2. More Class 2s have better maxillary projection than Class 3s. Class 2 doesn't always mean downward-grown.

 

[TheoRaven]

No. The maxilla extends all the way from the upper jaw to the middle of the eye sockets.
She clearly has infraorbital retrusion and a sunk paranasal area. The make-up and lighting make the result look better than it actually is.

The only thing I see is a lack of soft tissue support due to her cheekbones being retruded and lower than ideally set. Maybe that gives you the impression of a lack of maxillary projection in the midface?

For the vast majority of class 3s, the entire maxillary complex is underdeveloped. This usually comes with under-development of the infraoribital rims, paranasal hollowing, poor nasion projection. Most class 3s need implants to augment the upper maxilla.

Complete maxillary hypoplasia is exceedingly rare and primarily limited to severe class 3s or people with syndromes. Severe class 3s make up a tiny fraction of class 3 malocclusion patients, the vast majority of them have selective hypoplasia only affecting the lower portion. In the very few milder cases where some upper maxillary retrusion exists, it's so minor that it's completely masked by soft tissue.

 

[Snicket]

The only thing I see is a lack of soft tissue support due to her cheekbones being retruded and lower than ideally set. Maybe that gives you the impression of a lack of maxillary projection in the midface?

There's no impression, it's a fact. Her entire maxilla is underdeveloped.
I explained the features in her case: Infraorbital rim retrusion, paranasal hollowing.
You can tell she has a bony deficiency under the eyes and an under-developed naso-maxillary complex.

Complete maxillary hypoplasia is exceedingly rare and primarily limited to severe class 3s or people with syndromes. Severe class 3s make up a tiny fraction of class 3 malocclusion patients, the vast majority of them have selective hypoplasia only affecting the lower portion. In the very few milder cases where some upper maxillary retrusion exists, it's so minor that it's completely masked by soft tissue.

No. For most class 3s, hypoplasia of the maxilla extends all the way up to the infraorbital rims
Yes, it's less obvious compared to syndromic or very severe cases but it's still clinically recognisable as I pointed out in this woman's case.

While it's true that in most class 3s the dentoalveolar region is more recessed than the rest of the maxilla, it's clearly still an issue. Which is why many class 3s combine bimax with implants to augment the infraorbital rims.

In most cases, It's not severe enough to justify a high level osteotomy but enough to necessitate implants.

 

[Sicilian Cyclops]

Plus destroying your nose + philtrum.

what does it do to your philtrum? i'm already aware that it widens your alar base

 

[chrishell]

should have gotten monobloc + bsso

ok surgeon