Biretrusion or recessed mandible? Need help deciding a treatment plan

[whitepill_is_true]

I first posted here in january after my first consultation with a maxfac surgeon. He looked in my mouth for 5 minutes and decided I would get an 11mm BSSO. He told me later changes could be made and that we would meet up one more time for ceph photos to finalise treatment plans. After going home and doing some research I believe a Lefort 1 is also required/ would bring great improvement. But my knowledge is only rudimentary so I hope someone here has an answer to the following questions. Additionally, my surgery is provided by insurance and im afraid my surgeon is only focused on function, not aesthetics, and is underadvancing me. It would gut me if I do this shit and I still look like a fucking inbred recessed hillbilly.

1: Based on the pictures below, is only my mandible receded or my maxilla aswell? I have deep smile lines and large buccal corridors. In my side profile pictures my face seems flat, like everything below my eyes is recessed, including my infraorbital support, cheekbones and entire midface. I have a class II malocclusion.

2: Would I benefit from widening of the upper palate? I measured an IMW of 36 mm but I could be off and only my first 6 teeth are visible when smiling. I believe this indicates a narrow upper palate. But it is unfortately too late for MARPE as I just turned 18. Is a segmental LEFORT still possible?

3: Would a CCW rotation and advanced of the maxilla add cheekbone visibility and undereye support? I am severely lacking in those areas and I look like i've been awake for three days even after proper sleep.

4: How do I go about voicing my concerns to my surgeon if he still disagrees on a LEFORT after I ask him about it?

PS: for those who read and respond, ty you guys are the real chads

here are my pictures:

 

[whitepill_is_true]

Damn why aint no1 responding is my title too low IQ or what?

 

[LEFORT17]

I first posted here in january after my first consultation with a maxfac surgeon. He looked in my mouth for 5 minutes and decided I would get an 11mm BSSO. He told me later changes could be made and that we would meet up one more time for ceph photos to finalise treatment plans. After going home and doing some research I believe a Lefort 1 is also required/ would bring great improvement. But my knowledge is only rudimentary so I hope someone here has an answer to the following questions. Additionally, my surgery is provided by insurance and im afraid my surgeon is only focused on function, not aesthetics, and is underadvancing me. It would gut me if I do this shit and I still look like a fucking inbred recessed hillbilly.

1: Based on the pictures below, is only my mandible receded or my maxilla aswell? I have deep smile lines and large buccal corridors. In my side profile pictures my face seems flat, like everything below my eyes is recessed, including my infraorbital support, cheekbones and entire midface. I have a class II malocclusion.

2: Would I benefit from widening of the upper palate? I measured an IMW of 36 mm but I could be off and only my first 6 teeth are visible when smiling. I believe this indicates a narrow upper palate. But it is unfortately too late for MARPE as I just turned 18. Is a segmental LEFORT still possible?

3: Would a CCW rotation and advanced of the maxilla add cheekbone visibility and undereye support? I am severely lacking in those areas and I look like i've been awake for three days even after proper sleep.

4: How do I go about voicing my concerns to my surgeon if he still disagrees on a LEFORT after I ask him about it?

PS: for those who read and respond, ty you guys are the real chads

here are my pictures:
View attachment 3719164View attachment 3719167View attachment 3719169View attachment 3719173View attachment 3719174

so you got a 11mm overbite?

 

[whitepill_is_true]

yeah on my last post someone told me it was hard to spot due to my chin which isn't as recessed

 

[LEFORT17]

yeah on my last post someone told me it was hard to spot due to my chin which isn't as recessed

was thinking the same

 

[geenk worg]

Post your ceph and then we can talk. these profile pics aren't nearly good enough

 

[sham66]

yeah i was gonna respond but i got busy, my bad.

1: Based on the pictures below, is only my mandible receded or my maxilla aswell? I have deep smile lines and large buccal corridors. In my side profile pictures my face seems flat, like everything below my eyes is recessed, including my infraorbital support, cheekbones and entire midface. I have a class II malocclusion.

send a ceph, these pics arent good enough to determine if u need lefort or not

2: Would I benefit from widening of the upper palate? I measured an IMW of 36 mm but I could be off and only my first 6 teeth are visible when smiling. I believe this indicates a narrow upper palate. But it is unfortately too late for MARPE as I just turned 18. Is a segmental LEFORT still possible?

hm sure. the IMW distance doesnt seem that bad, but 6 teeth showing is a sign of a narrow palate. ur restricted by ur mandible in how much u can expand, so keep that in mind. btw, marpe is possible for adults man

4: How do I go about voicing my concerns to my surgeon if he still disagrees on a LEFORT after I ask him about it?

first confirm if u need a lefort 1. if confirmed that u need it, ask him a question in an ignorant way, such as “but what if my bones over here are left behind?”

PS: for those who read and respond, ty you guys are the real chads

 

[whitepill_is_true]

My ceph is planned in the last week of july, it will hopefully bring clarity. I thought after a certain age only SARPE was possible, I didn't know MARPE was also possible. With the mandible restricting maxillary expansion you mean because of the teeth not fitting? I will gather some more information and talk about more agressive advancement, underadvancement is my biggest fear atm. thanks for the response

yeah i was gonna respond but i got busy, my bad.


send a ceph, these pics arent good enough to determine if u need lefort or not

hm sure. the IMW distance doesnt seem that bad, but 6 teeth showing is a sign of a narrow palate. ur restricted by ur mandible in how much u can expand, so keep that in mind. btw, marpe is possible for adults man

first confirm if u need a lefort 1. if confirmed that u need it, ask him a question in an ignorant way, such as “but what if my bones over here are left behind?”

 

[sham66]

My ceph is planned in the last week of july, it will hopefully bring clarity. I thought after a certain age only SARPE was possible, I didn't know MARPE was also possible. With the mandible restricting maxillary expansion you mean because of the teeth not fitting? I will gather some more information and talk about more agressive advancement, underadvancement is my biggest fear atm. thanks for the response

yeah itll def help a bunch.

yeah sorta. a surgeon once said that u cant expand too much in the palate, because then ur upper teeth would get too wide, with ur lower teeth being too narrow.

lol dw, slight under advancement is better than a botched over advancement

 

[DonaldJTrump]

i wouldnt recommend jaw surgery unless you have health issues or MAYBE if you have zero chin/severe sfs/severely counter clockwise rotated jaws (So I don't recommend you get this for cosmetic purposes)