CCW Impaction or just weak lower third? CBCT SCAN

[CoeurSurIlo]

my CBCT scans looks good, I mean gonial angle wise, but I don't know if getting CCW with down grafting would solve my quite short face issue or would it make it worse?
Scheduled for a DJS + Genio end of July, but still just thinking of what I should really get done, before even any preplanning 3D imaging happens.

From the front, my face appears slightly elongated considering I have a short face, but from my side my face appears short? Do I simply get forward linear movement and no impaction at all, to make my lower third appear stronger? Even though I believe CCW would be best in my case with downward grafting.

IMPORTANT TO NOTE: I had overbite as a kid, then had braces to fix my bite, and now I'm wearing invisalign with elastics as per my surgeon's advice in order to push my lower teeth back so he can have more space for forward movement once he's doing the procedure.

 

[lurking truecel]

Your jaw looks good, doing bimax in your case is retarded

 

[geenk worg]

I think it's worth it. You don't have a short face, you're just recessed. I made you a morph that would show what's possible with bimax

And here's a milder one:

 

[Snicket]

View attachment 3511495

I think it's worth it. You don't have a short face, you're just recessed. I made you a morph that would show what's possible with bimax
View attachment 3511496
And here's a milder one:
View attachment 3511497

I swear short face has become a buzzword or something around here.

Even in his scans, you can tell that his maxilla has zero vertical deficiency.

 

[CoeurSurIlo]

Your jaw looks good, doing bimax in your case is retarded

No it's not, it's the only real way to fix my underlying issue I've had since I was a kid.

View attachment 3511495

I think it's worth it. You don't have a short face, you're just recessed. I made you a morph that would show what's possible with bimax
View attachment 3511496
And here's a milder one:
View attachment 3511497

Thanks, I already did some myself even though I can't necessarily replicate what it will actually look like. The smallest I'm willing to do on my maxilla is 4mm and 8 to 10mm for my lower jaw, mainly because I want to fix my deep mentolabial fold. Genio would look retarded on me, so this is what I'll likely end up doing without any impaction just straight up forward movement

 

[Evgeniy291]

my CBCT scans looks good, I mean gonial angle wise, but I don't know if getting CCW with down grafting would solve my quite short face issue or would it make it worse?
Scheduled for a DJS + Genio end of July, but still just thinking of what I should really get done, before even any preplanning 3D imaging happens.

From the front, my face appears slightly elongated considering I have a short face, but from my side my face appears short? Do I simply get forward linear movement and no impaction at all, to make my lower third appear stronger? Even though I believe CCW would be best in my case with downward grafting.

IMPORTANT TO NOTE: I had overbite as a kid, then had braces to fix my bite, and now I'm wearing invisalign with elastics as per my surgeon's advice in order to push my lower teeth back so he can have more space for forward movement once he's doing the procedure.

It’s the philtrum boyo

 

[CoeurSurIlo]

I swear short face has become a buzzword or something around here.

Even in his scans, you can tell that his maxilla has zero vertical deficiency.

I didn't say SFS, just generally a short face

 

[CoeurSurIlo]

It’s the philtrum boyo

none of what I said has anything to do with my philtrum, it could have been twice as long and still wouldn't address any concerns I had in the initial post.

 

[Snicket]

I didn't say SFS, just generally a short face

You don't have a short face though. It's on the longer side.
Your midface is not compact and you clearly have mild downward growth.

From the side profile, your mandible is a little short but a short mandible \= short face.

Downgrafting does not mean you have a short face either.
Posterior downgrafting for example causes CCW rotation, which can be used to address downward growth in your case.

I suspect that the side profile will improve but frontal will barely change at all.

I'm increasingly convinced that bimax is best for cases with significant recession, otherwise the results are underwhelming.

I like your pfp though.

 

[CoeurSurIlo]

You don't have a short face though. It's on the longer side.
Your midface is not compact and you clearly have mild downward growth.

From the side profile, your mandible is a little short but a short mandible \= short face.

Downgrafting does not mean you have a short face either.
Posterior downgrafting for example causes CCW rotation, which can be used to address downward growth in your case.

I suspect that the side profile will improve but frontal will barely change at all.

I'm increasingly convinced that bimax is best for cases with significant recession, otherwise the results are underwhelming.

I like your pfp though.

Thx,
I believe my side profile will be more harmonious, I just want better convexity and a steeper mendolabial fold angle, I do not have unrealistic expectations.

Pardon my dumb question, but what exactly would be the difference between Impaction CCW vs Posterior down grafting? I do not have a gummy smile, or very very barely, would this be the way to go, and what other angles does it affect besides shortening mid face? That's the only information I've briefly went over since seeing your answer.

 

[Snicket]

Thx,
I believe my side profile will be more harmonious, I just want better convexity and a steeper mendolabial fold angle, I do not have unrealistic expectations.

Good to have realistic expectations. You’ll get the side profile improvement you’re looking for.

Pardon my dumb question, but what exactly would be the difference between Impaction CCW vs Posterior down grafting? I do not have a gummy smile, or very very barely, would this be the way to go, and what other angles does it affect besides shortening mid face?

Not a dumb question. I’ll explain in basic terms.

Where the cut is made on the maxilla and whether you remove bone (impact) or create a gap (downgraft) will affect the direction of rotation

Anterior = Front of maxilla
Posterior = Back of maxilla

Posterior impaction = CCW
Anterior Impaction = CW
Posterior downgraft = CCW
Posterior impaction = CW

An anterior impaction is CCW. If you don’t have a gummy smile then it’s generally not recommended.

Posterior downgraft lengthens the back of the maxilla and causes it to upswing along with the mandible.

Imagine the upper jaw as a pencil where front is anterior (the teeth) and back is posterior. Play around with a pencil by rotating it from a fixed point.

It’s easier to visualize the movements that way.

Hope that clarifies things.

 

[CoeurSurIlo]

Good to have realistic expectations. You’ll get the side profile improvement you’re looking for.

Not a dumb question. I’ll explain in basic terms.

Where the cut is made on the maxilla and whether you remove bone (impact) or create a gap (downgraft) will affect the direction of rotation

Anterior = Front of maxilla
Posterior = Back of maxilla

Posterior impaction = CCW
Anterior Impaction = CW
Posterior downgraft = CCW
Posterior impaction = CW

An anterior impaction is CCW. If you don’t have a gummy smile then it’s generally not recommended.

Posterior downgraft lengthens the back of the maxilla and causes it to upswing along with the mandible.

Imagine the upper jaw as a pencil where front is anterior (the teeth) and back is posterior. Play around with a pencil by rotating it from a fixed point.

It’s easier to visualize the movements that way.

Hope that clarifies things.

Thank you for explaining, I'll look more into it. Have a great day

 

[monecel]

View attachment 3511495

I think it's worth it. You don't have a short face, you're just recessed. I made you a morph that would show what's possible with bimax
View attachment 3511496
And here's a milder one:
View attachment 3511497

This would actually be a really top side profile, it would also improve the eye vector as well

 

[Acne Victim]

@CoeurSurIlo you have a good base for surgery. you look a lot like me pre bimax too, especially from the side. Here are some things that might help you, from personal experience:

- Do NOT get linear advancement alone. You NEED ccw rotation if you want a proper result, and it's most likely gonna be posterior downgraft and not anterior impaction. If you have a gummy smile, and one that comes from a vertical maxillary excess (aka not short teeth/gums), then it's better you don't mess with impaction at all

- Bimax might not necessarily fix your mentolabial fold. I know there is a saying that "if you have a deep MF, then you need bimax, not genio" which is somewhat true, but it also sort of implies that it will be fixed with bimax. From my personal experience (which is likely gonna be close to yours), the difference was close to zero. Sadly, this isn't an issue I have a solution for yet, but it just doesn't seem so clear as to if you get advancement on the jaw it's fixed

Just remember I'm not a surgeon, so take this with a grain of salt

Your jaw looks good, doing bimax in your case is retarded

He is clearly a bimax candidate...

 

[lurking truecel]

@CoeurSurIlo you have a good base for surgery. you look a lot like me pre bimax too, especially from the side. Here are some things that might help you, from personal experience:

- Do NOT get linear advancement alone. You NEED ccw rotation if you want a proper result, and it's most likely gonna be posterior downgraft and not anterior impaction. If you have a gummy smile, and one that comes from a vertical maxillary excess (aka not short teeth/gums), then it's better you don't mess with impaction at all

- Bimax might not necessarily fix your mentolabial fold. I know there is a saying that "if you have a deep MF, then you need bimax, not genio" which is somewhat true, but it also sort of implies that it will be fixed with bimax. From my personal experience (which is likely gonna be close to yours), the difference was close to zero. Sadly, this isn't an issue I have a solution for yet, but it just doesn't seem so clear as to if you get advancement on the jaw it's fixed

Just remember I'm not a surgeon, so take this with a grain of salt


He is clearly a bimax candidate...

If he have functional issues sure, but doing bimax with a straight nose and already long phil is retarded

 

[Acne Victim]

If he have functional issues sure, but doing bimax with a straight nose and already long phil is retarded

What? His lower third will literally be elongated after trimax jfl. That will make it more balanced if anything, as long as he doesn't go overboard on chin height obviously.

 

[LancasteR]

@CoeurSurIlo you have a good base for surgery. you look a lot like me pre bimax too, especially from the side. Here are some things that might help you, from personal experience:

- Do NOT get linear advancement alone. You NEED ccw rotation if you want a proper result, and it's most likely gonna be posterior downgraft and not anterior impaction. If you have a gummy smile, and one that comes from a vertical maxillary excess (aka not short teeth/gums), then it's better you don't mess with impaction at all

- Bimax might not necessarily fix your mentolabial fold. I know there is a saying that "if you have a deep MF, then you need bimax, not genio" which is somewhat true, but it also sort of implies that it will be fixed with bimax. From my personal experience (which is likely gonna be close to yours), the difference was close to zero. Sadly, this isn't an issue I have a solution for yet, but it just doesn't seem so clear as to if you get advancement on the jaw it's fixed

Just remember I'm not a surgeon, so take this with a grain of salt


He is clearly a bimax candidate...

Based user helping others out

 

[lurking truecel]

What? His lower third will literally be elongated after trimax jfl. That will make it more balanced if anything, as long as he doesn't go overboard on chin height obviously.

Balanced what ? He will ascend 0,25 psl points from the side and might descend from front for 15k euro + 3k euro(orthodontics and braces). And on top that take all the risk that comes with bimax surgery. Thats stupidily retarded, doing bimsx without any health issues or severe deformity is mental illness

 

[lurking truecel]

Based user helping others out

Based to say that someone should spend 20k + atleast, much more if you want a bp doctor for zero gain in psl from the front? He doesnt have any deformity that bimax would help from front, he would ascend 0.25 psl from the side. Because his lower jaw is recessed by 5 mm at most

 

[Acne Victim]

Balanced what ? He will ascend 0,25 psl points from the side and might descend from front for 15k euro + 3k euro(orthodontics and braces). And on top that take all the risk that comes with bimax surgery. Thats stupidily retarded, doing bimsx without any health issues or severe deformity is mental illness

I ascended easily more than 0.25 PSL with bimax and our base is quite similar. Anyone who has seen me can vouch

Unless he has some rare and serious complication, the chances of him descending are almost negligible, assuming he is prudent with the advancement

Besides, he most likely will get improved sleep, breathing, and just better overall day to day life as these things are directly tied down to it.

You're spewing nonsense

 

[LancasteR]

Based to say that someone should spend 20k + atleast, much more if you want a bp doctor for zero gain in psl from the front? He doesnt have any deformity that bimax would help from front, he would ascend 0.25 psl from the side. Because his lower jaw is recessed by 5 mm at most

He has biretrusion even though his alignment doesn't look bad.
But not fixing it could give him sleep and airway problems and detoriate his TMJ sooner or later.
Also it's his choice. Not saying he should or shouldn't do it.

 

[lurking truecel]

I ascended easily more than 0.25 PSL with bimax and our base is quite similar. Anyone who has seen me can vouch

Unless he has some rare and serious complication, the chances of him descending are almost negligible, assuming he is prudent with the advancement

Besides, he most likely will get improved sleep, breathing, and just better overall day to day life as these things are directly tied down to it.

You're spewing nonsense

If you looked like this guy you couldnt have ascended from the front atleast, his maxilla is not recessed even 1 mm. And his mandible is not recessed either to the pint it will cause any sleep issues. You are delusional to give so stupid advices, risk to reward is zero here. Making yourself swollen and numb for 3+ months and noticeable swelling for over a year for 0.25 psl from the side is delusional and wageslaving for a year or two for it is retarded to next level

 

[lurking truecel]

He has biretrusion even though his alignment doesn't look bad.
But not fixing it could give him sleep and airway problems and detoriate his TMJ sooner or later.
Also it's his choice. Not saying he should or shouldn't do it.

Its bad bite that detoriates the tmjs, doing bimax have a higher risk of tmj disorders( moving lower jaw forward makes more force on the condyle). Esp since the OPs condyle is posteriorly projected. Risk to reward is zero here. He already looks good from the front and bimax would make zero diffrence

 

[Acne Victim]

If you looked like this guy you couldnt have ascended from the front atleast, his maxilla is not recessed even 1 mm. And his mandible is not recessed either to the pint it will cause any sleep issues. You are delusional to give so stupid advices, risk to reward is zero here. Making yourself swollen and numb for 3+ months and noticeable swelling for over a year for 0.25 psl from the side is delusional and wageslaving for a year or two for it is retarded to next level

If you can't see how much he stands to gain, then you might as well be saying surgery is an absolute cope my friend

Or you're just trying to kill the competition

 

[LancasteR]

Its bad bite that detoriates the tmjs, doing bimax have a higher risk of tmj disorders( moving lower jaw forward makes more force on the condyle). Esp since the OPs condyle is posteriorly projected. Risk to reward is zero here. He already looks good from the front and bimax would make zero diffrence

OP literally said he had his malocclusion fixed with braces as a kid but how you can see his skeletal malocclusion still persists. Which can damage the TMJ.
Also his lower jaw being trapped behind his upper jaw because the teeth rows were squeezed together to "align" meanwhile his jaws are still recessed, biretrusion.

Also posteriorly positioned condyle doesn't have to mean anything as he clearly already has mild/moderate head forward posture because of his (still unfixed) jaw misalignment. Maybe his body compensating through the posture for below average airway/jaw misalignment.

 

[lurking truecel]

OP literally said he had his malocclusion fixed with braces as a kid but how you can see his skeletal malocclusion still persists. Which can damage the TMJ.
Also his lower jaw being trapped behind his upper jaw because the teeth rows were squeezed together to "align" meanwhile his jaws are still recessed, biretrusion.

Also posteriorly positioned condyle doesn't have to mean anything as he clearly already has mild head forward posture because of his (still unfixed) jaw misalignment. Maybe his body compensating through the posture.

He obv already have some kind of tmj issues, one of his ramuses are a lot longer which comes from condyle issues probably because he had malocclusion for some time making it even more risky to do bimax esp with posteriorly projected condyles. And his bite is fixed now which makes the condyles stable, making it unstable and moving jaws. forward and esp with ccw will put pressure on the condyles. His posture looks good, and its 70% of all people who have jaws like that or worse. Spending 1 year in braces, risking all the complication with bimax, wageslaving for years, for almost zero psl gain with no prior medical issues. Making skeletal assymetries more prounced, they will not lengthen the ramus on one side. Its not worth it

 

[lurking truecel]

If you can't see how much he stands to gain, then you might as well be saying surgery is an absolute cope my friend

Or you're just trying to kill the competition

What gains will he have from the front that matters, OP looks good, his skeletal assymetries with the ramus being longer on one side is almost not noticable, doing bimax movements forward will make these assymetries more prounced. Overall gain will be zero from the front. And from the side its not guaranteed ascension either, having a long phil and straight nose before bimax is two very good reasons not to do bimax. Just making the phil slightly longer is death sentence. Making nose more upturned or wider from front with the narrow lips is death also

 

[LancasteR]

He obv already have some kind of tmj issues, one of his ramuses are a lot longer which comes from condyle issues probably because he had malocclusion for some time making it even more risky to do bimax esp with posteriorly projected condyles. And his bite is fixed now which makes the condyles stable, making it unstable and moving jaws. forward and esp with ccw will put pressure on the condyles. His posture looks good, and its 70% of all people who have jaws like that or worse. Spending 1 year in braces, risking all the complication with bimax, wageslaving for years, for almost zero psl gain with no prior medical issues. Making skeletal assymetries more prounced, they will not lengthen the ramus on one side. Its not worth it

It doesn't look normal at all. His posture makes him tilt his head and neck forward.
He should atleast get his airway checked out and look if it's at risk for becoming narrower or developing sleep disordered breathing (UARS or Sleep Apnea)
Also bimax can fix skeletal asymmetries actually if the surgeon has good planning methods.
+ fix that weird mentolabial fold look if a genio is added alongside and will generally make him look better for fixing the skeletal malocclusion and adding the missing mandible length

 

[lurking truecel]

It doesn't look normal at all. His posture makes him tilt his head and neck forward.
He should atleast get his airway checked out and look if it's at risk for becoming narrower or developing sleep disordered breathing (UARS or Sleep Apnea)
Also bimax can fix skeletal asymmetries actually if the surgeon has good planning methods.
+ fix that weird mentolabial fold look if a genio is added alongside and will generally make him look better for fixing the skeletal malocclusion and adding the missing mandible length

You cant fix shorter ramus on one side(apart from with a risky french split cut) snd mass assymetries, he already have similar length on the both mandible bodies which is what can be fixed with the bsso cut. Yes sure, he should do a sleep study. If he have any signs at his age he should go ahead. I am not against bimax when its needed. But its a brutal surgery and expensive. So not worth if not for health or really bad deformity

 

[LancasteR]

You cant fix shorter ramus on one side(apart from with a risky french split cut) snd mass assymetries, he already have similar length on the both mandible bodies which is what can be fixed with the bsso cut. Yes sure, he should do a sleep study. If he have any signs at his age he should go ahead. I am not against bimax when its needed. But its a brutal surgery and expensive. So not worth if not for health or really bad deformity

If he can get a stronger and more masculine looking jaw and fix future health risks or one's that he now potentially has because of the skeletal misalignment, then that's a plus in my book.
But the choice is still his.
Picking good maxfac surgeons with good planning will negate 90% of the possible complications or atleast reduce them drastically.

 

[lurking truecel]

If he can get a stronger and more masculine looking jaw and fix future health risks or one's that he now potentially has because of the skeletal misalignment, then that's a plus in my book.
But the choice is still his.
Picking good maxfac surgeons with good planning will negate 90% of the possible complications or atleast reduce them drastically.

He already have a good jaw from the front, many good looking people have slight recession. If he have 20k + euros and a 1,5 year to spare, then he should do it.

 

[LancasteR]

He already have a good jaw from the front, many good looking people have slight recession. If he have 20k + euros and a 1,5 year to spare, then he should do it.

He looks normal but "good" is exaggerated. Undimorphic and not so developed looking either, but not massively underdeveloped or "deformed" either.
But a bit more recessed than the average person.
I'd say normie after looksmaxxing.