Criteria for ascending hard via jaw surgery

[ltn_looksminner]

Kinda useless, its more a selling a point. Any bsso will widen your jaw a few mm

the issue is it wouldn't really do that though , it's more of an illusion because of the projection right ?

 

[Prøphet]

Best thread I’ve seen in weeks

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I’ve been looking for this one, his lower third is so similar to mine, mirin the lifefuel

 

[yussimania]

I think I hit a few of the criteria.

bad class 2, Okayish gonion width without needing implants and the sfs 0 gingival and upper incisor show smile.

Also no Ramieri in this thread? Does he not have the same level of results as Alfaro? Another thing I noticed is that you said overbite but I think the right term should be overjet as that is more indicative of a class 2 skeletal relationship where the lower jaw is recessed since overbite is a dental indicator.


Great thread as always thank you.

 

[lurking truecel]

the issue is it wouldn't really do that though , it's more of an illusion because of the projection right ?

Nah it widen, because of how segments come forward. But most jaw surgeons or the standard is to make the condyles move as little as possible. But it happens automatically

 

[lurking truecel]

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I think I hit a few of the criteria.

bad class 2, Okayish gonion width without needing implants and the sfs 0 gingival and upper incisor show smile.

Also no Ramieri in this thread? Does he not have the same level of results as Alfaro? Another thing I noticed is that you said overbite but I think the right term should be overjet as that is more indicative of a class 2 skeletal relationship where the lower jaw is recessed since overbite is a dental indicator.


Great thread as always thank you.

Ram compared to raffaini and alfaro is relatively conservative which makes the result less impressive.

 

[lurking truecel]

I have a borderline short face as you can see by my scans.

I have a long ramus and well rotated jaw, which I think fits the criteria, although I have a class 1 dental occlusion, we’re going to decompensate my teeth as much as possible, so I can get a bigger movement.

Do you think a small bit of downgrafting is necessary? I’m also gonna add height and width to my chin with custom genio.

My surgeon is gonna do roughly a 12mm BSSO and 5mm Lefort 1. Haven’t decided genio movements yet.

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I don’t have great gonion flare, however I’m just gonna chew and build my masseters for lower third width.


Thoughts on everything? @lurking truecel

One easy way to see if you need downgraft is to relax the mouth, open it. If you dont see your teeth or just very slightly see teeth when you relax you need some downgraft. But its a balance because doing forward movement will also reveal a little bit.

Yes you want to compensate as much as possible as you want the whole lower jaw to come forward as much as possible so you dont need to compensate with genio much. Genio should ideally be just for vertical changes. I think flaring will be good for you.

I wouldnt add chin width because you dont need it, ideally you dont need genio at all apart from vertical maybe if the decomp goes well

 

[nortaa4]

I think you'd benefit from jaw angle implants tbh. Thing is- people go overboard and construct very strong uncanny looking implants, not accounting for the thicker soft tissue in that region, which makes these implants look bad. But if you go conservative, you can get a decent result.

Im considering implants after I have recovered from bimax. People have said online that if you are recessed and just do implants you will look ridiculous

 

[jackinthebox]

what would you suggest to people with poor gonion definition/lack of downward growth but good bite/projection/side profile?

can you get downgrafts with no advancement and just angularity + to stretch your cheeks?

 

[axttt_]

I don’t possess most traits mentioned but my jaw is recessed , if not bimax then what do you think is best , also why is it you think angle implants look bad

 

[lurking truecel]

what would you suggest to people with poor gonion definition/lack of downward growth but good bite/projection/side profile?

can you get downgrafts with no advancement and just angularity + to stretch your cheeks?

That would be ridicoulous. Then implants or fillers is the better option. Maybe mse or whatever. But doing only downgraft for stretching of soft tissue would not performed by any serious surgeon. And you would need extreme sfs to even consider it

 

[tweaqo]

One easy way to see if you need downgraft is to relax the mouth, open it. If you dont see your teeth or just very slightly see teeth when you relax you need some downgraft. But its a balance because doing forward movement will also reveal a little bit.

Yes you want to compensate as much as possible as you want the whole lower jaw to come forward as much as possible so you dont need to compensate with genio much. Genio should ideally be just for vertical changes. I think flaring will be good for you.

I wouldnt add chin width because you dont need it, ideally you dont need genio at all apart from vertical maybe if the decomp goes well

Yeah that’s what the surgeon said. That I might not even need genio, at least not a big one. However I will still get one for best aesthetic outcome, a small one for height, width and small forward projection.

He said i will gain alot of face height even without downgrafting maxilla, just by bringing my jaw forward.

Before I had camouflage orthodontics, I had textbook SFS indicators, like very little teet/gum show when smiling, collapsed looking chin, with deep mentolabial fold etc.

But since getting braces, all of these have been masked, now I’m getting decomp, they will all come back again before jaw surgery.

Man decomp is gonna be hard, I will look so ugly

 

[lurking truecel]

I don’t possess most traits mentioned but my jaw is recessed , if not bimax then what do you think is best , also why is it you think angle implants look bad

Angle implants often looks bad because its the muscle that usually creates the angle. The bone is 1 cm deep buried in soft tissue no matter what kind of gonion width you have. Deattaching and attaching the masster muscle to the implant or have the implant lower then the muscle insertion itself often doesnt look good.

 

[tweaqo]

Yrah i dont see many of my teeth when I open my mouth like u said, maybe a small downgraft would help

 

[lurking truecel]

Yeah that’s what the surgeon said. That I might not even need genio, at least not a big one. However I will still get one for best aesthetic outcome, a small one for height, width and small forward projection.

He said i will gain alot of face height even without downgrafting maxilla, just by bringing my jaw forward.

Before I had camouflage orthodontics, I had textbook SFS indicators, like very little teet/gum show when smiling, collapsed looking chin, with deep mentolabial fold etc.

But since getting braces, all of these have been masked, now I’m getting decomp, they will all come back again before jaw surgery.

Man decomp is gonna be hard, I will look so ugly

i wouldnt just do a small genio for width and projection. All things look better untouched, it should be a good indicator as to why you need to widen. Not just a mm here and there. The accuracy can be off by a mm litteraly. When i look at your chin i dont see any indication of a genio, and rams genios and many other surgeons to are unfortunately not the best.

 

[lurking truecel]

Yrah i dont see many of my teeth when I open my mouth like u said, maybe a small downgraft would help

you should see like 2-3 mm of teeth when doing this while being relaxed in the upper lip, Open slightly less then in this pic

 

[tweaqo]

i wouldnt just do a small genio for width and projection. All things look better untouched, it should be a good indicator as to why you need to widen. Not just a mm here and there. The accuracy can be off by a mm litteraly. When i look at your chin i dont see any indication of a genio, and rams genios and many other surgeons to are unfortunately not the best.

Okok thanks for the advice I will talk to him about this and see what we can do.

Also when I look at my CT scan and skull, it looks like I have asymmetry of the chin, this also appears to be the case when I look at my face too, here is the soft tissue scan of my face

It’s also worth mentioning that I used to have a cross bite, before orthodontics, is this fixeable?

 

[tweaqo]

View attachment 4403689 you should see like 2-3 mm of teeth when doing this while being relaxed in the upper lip, Open slightly less then in this pic

Fuck I have almost no teeth show

 

[lurking truecel]

Okok thanks for the advice I will talk to him about this and see what we can do.

Also when I look at my CT scan and skull, it looks like I have asymmetry of the chin, this also appears to be the case when I look at my face too, here is the soft tissue scan of my faceView attachment 4403692

It’s also worth mentioning that I used to have a cross bite, before orthodontics, is this fixeable?

I mean i dont see the assymetry, and assymetry is not 1 to 1 with bone. You could fix the bone assymetry but it would still look equally assymetric because soft tissue is formed that way. Bringing the lower jaw forward can expose new assymetries aswell. One of the downsides

 

[lurking truecel]

Fuck I have almost no teeth show

The thing is you still dont want to make huge down graft and make lower third to vertically high. You already got relatively or actually normal lower third height.so down graft might not be an option either way and you will need to rely on the forward movent to expose teeth instead

Also their is one alternative to make the teeth show more

 

[tweaqo]

The thing is you still dont want to make huge down graft and make lower third to vertically high. You already got relatively or actually normal lower third height.so down graft might not be an option either way and you will need to rely on the forward movent to expose teeth instead

Ok that is true, also considering the fact I am doing a large lower movement, which surprised me that a surgeon is willing to do that much on me. He said a downgraft is possible, but only a very small.

 

[lurking truecel]

Ok that is true, also considering the fact I am doing a large lower movement, which surprised me that a surgeon is willing to do that much on me. He said a downgraft is possible, but only a very small.

The movements also depends slightly how you measure. If you ask pag for movements he will only give you the forward movement from the side. While ramieri will give you the bone seperation movements. So if you watch clearly from the side, 10 mm bone seperation would give like 7 mm of actual diffrence.

 

[axttt_]

Angle implants often looks bad because its the muscle that usually creates the angle. The bone is 1 cm deep buried in soft tissue no matter what kind of gonion width you have. Deattaching and attaching the masster muscle to the implant or have the implant lower then the muscle insertion itself often doesnt look good.

So would you say short ramus height is a flaw one just has to live with or there’s something else that can be done

 

[tweaqo]

The movements also depends slightly how you measure. If you ask pag for movements he will only give you the forward movement from the side. While ramieri will give you the bone seperation movements. So if you watch clearly from the side, 10 mm bone seperation would give like 7 mm of actual diffrence.

That is interesting, so would the actual measurement that actually matters be on the pogonion?