how much bsso advancement can you get with a blackpilled surgeon?

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goodman78

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why is relapse happening on more extreme advancements i dont understand it.. isnt the split jaw connected with plates or something until the new bone is formed?

are there any other surgical ways to prevent a relapse from happening?

approximately what is a risky amount of advancement and if the relapse happens i guess it has to be just a few milimeters right?
 
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@Sergio-OMS
@Golden Glass
 
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i wouldnt recommend going over 10
 
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relapse and risk
risk about permanent numbness etc? about the relapse, do you mean a total relapse? ofc not right? so it could be by a few mms?

btw i dont understand how relapse happens with bigger advancements, is it because the new bone cant be formed? sorry im stupid i just cant wrap my head around it
 
my surgey will be 8mm bsso advancement
 
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ok there are two things to consider at this point.

One is the advancement of the chin points (menton, pogonion, whichever you prefer) that is achieved by a combination of the actual BSSO advancement (the gap of the osteotomy) and the autorrotation of the mandible (for instance, if there is an upper jaw impaction, both jaws will have a counter clockwise rotation and the chin points will advance. There will be a stretch of the soft tissues (skin, muscles) that will affect the gap but it is nothing compared to the advancement done by the actual gap.

The gap achieved by the osteotomy is more unstable. Some studies recommend not creating gaps larger than 7 mm with BSSO and recommend addressing those gaps by distraction osteogenesis.

But, actually, my last patient had gaps of 10 and 12 mm, and the one before last had 15 mm maps... I am really crossing my fingers.... it is way too much but there was no other way.

I believe that the use of custom designed and printed titanium plates can reduce the risk of complications to a minimum and, but there was no way I could use those with these last two patients.
 
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ok there are two things to consider at this point.

One is the advancement of the chin points (menton, pogonion, whichever you prefer) that is achieved by a combination of the actual BSSO advancement (the gap of the osteotomy) and the autorrotation of the mandible (for instance, if there is an upper jaw impaction, both jaws will have a counter clockwise rotation and the chin points will advance. There will be a stretch of the soft tissues (skin, muscles) that will affect the gap but it is nothing compared to the advancement done by the actual gap.

The gap achieved by the osteotomy is more unstable. Some studies recommend not creating gaps larger than 7 mm with BSSO and recommend addressing those gaps by distraction osteogenesis.

But, actually, my last patient had gaps of 10 and 12 mm, and the one before last had 15 mm maps... I am really crossing my fingers.... it is way too much but there was no other way.

I believe that the use of custom designed and printed titanium plates can reduce the risk of complications to a minimum and, but there was no way I could use those with these last two patients.

Insane IQ mogger
 
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ok there are two things to consider at this point.

One is the advancement of the chin points (menton, pogonion, whichever you prefer) that is achieved by a combination of the actual BSSO advancement (the gap of the osteotomy) and the autorrotation of the mandible (for instance, if there is an upper jaw impaction, both jaws will have a counter clockwise rotation and the chin points will advance. There will be a stretch of the soft tissues (skin, muscles) that will affect the gap but it is nothing compared to the advancement done by the actual gap.

The gap achieved by the osteotomy is more unstable. Some studies recommend not creating gaps larger than 7 mm with BSSO and recommend addressing those gaps by distraction osteogenesis.

But, actually, my last patient had gaps of 10 and 12 mm, and the one before last had 15 mm maps... I am really crossing my fingers.... it is way too much but there was no other way.

I believe that the use of custom designed and printed titanium plates can reduce the risk of complications to a minimum and, but there was no way I could use those with these last two patients.

perfect, i might understand what youre saying to an extent

by the way why werent those patients available for the titanium plates? was it cost/personal issue related or it was just not possible?

my last question is, talking about relapsie .. to what % of the final result could an overadvanced bsso relapse? might be a dumb question but could you give an approximation? did your patients experience any permanent nerve damage?
 
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perfect, i might understand what youre saying to an extent

by the way why werent those patients available for the titanium plates? was it cost/personal issue related or it was just not possible?

Cost. Normal plates are very cheap compared to custom specific cutting guides and 3d printed plates.
 
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Cost. Normal plates are very cheap compared to custom specific cutting guides and 3d printed plates.

[/QUOTE]
my last question is, talking about relapsie .. to what % of the final result could an overadvanced bsso relapse? might be a dumb question but could you give an approximation? did your patients experience any permanent nerve damage?

thank you for taking time to answer me in advance
 
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my last question is, talking about relapsie .. to what % of the final result could an overadvanced bsso relapse? might be a dumb question but could you give an approximation? did your patients experience any permanent nerve damage?


Sorry, I forgot to answer this part.

Actually I don't know in my patients, I haven't followed them much. They had their orthodontic treatment done and then "disappeared". Last time I looked into this I found several articles that described 15-20 % relapse (meaning each and every patient would suffer that relapse). I have just done a quick search and you can read the conclusions of this paper, which actually describes more.

The literature describes a similar degree of damage or relapse in distraction osteogenesis or single step mandibular advancement but this is due to the fact that those studies are comparing groups of patients that have been treated both with BSSO (BSSO acronym only stands for the design of the osteotomy, although everyone uses it to describe the whole procedure).

I honestly believe that nerve damage descriptions in the literature and in conference lectures and their coffee break discussions are just unreliable and false. There is no standarised way to measure and communicate that. Some surgeons will ask and examine this possible complication on every postop and will do long term followups, others won't. There are just so many possible biases.... And the anatomy is different in each patient. Having a nerve close to the outer cortex produces a high risk for damage. And, to be honest, most people lie. Also many surgeons, we are not an exception.

In my experience IMDO has a much lower risk of nerve damage because of the design of the osteotomy, although I can't really tell about the relapse because I have been doing it for not so many years and because I don't make my patients come back after finishing the process unless I feel it is necessary necessary or they ask for an appointment.
 
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ok there are two things to consider at this point.

One is the advancement of the chin points (menton, pogonion, whichever you prefer) that is achieved by a combination of the actual BSSO advancement (the gap of the osteotomy) and the autorrotation of the mandible (for instance, if there is an upper jaw impaction, both jaws will have a counter clockwise rotation and the chin points will advance. There will be a stretch of the soft tissues (skin, muscles) that will affect the gap but it is nothing compared to the advancement done by the actual gap.

The gap achieved by the osteotomy is more unstable. Some studies recommend not creating gaps larger than 7 mm with BSSO and recommend addressing those gaps by distraction osteogenesis.

But, actually, my last patient had gaps of 10 and 12 mm, and the one before last had 15 mm maps... I am really crossing my fingers.... it is way too much but there was no other way.

I believe that the use of custom designed and printed titanium plates can reduce the risk of complications to a minimum and, but there was no way I could use those with these last two patients.

Dr Sergio, what about genioplasty and Le Fort? How much is the maximum that can be advanced?
 
Dr Sergio, what about genioplasty and Le Fort? How much is the maximum that can be advanced?

It is very difficult to advance the upper jaw more than 8-9 mm, the soft tissues are very tight... with the chin it is easier.
 
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It is very difficult to advance the upper jaw more than 8-9 mm, the soft tissues are very tight... with the chin it is easier.

How much would you be the most for the chin?


In summary, what can help to make more great advances would be:
-Rotation
-Custom titanium plates
-Bone grafts
-Presurgical braces

Is there something else?
 
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ok there are two things to consider at this point.

One is the advancement of the chin points (menton, pogonion, whichever you prefer) that is achieved by a combination of the actual BSSO advancement (the gap of the osteotomy) and the autorrotation of the mandible (for instance, if there is an upper jaw impaction, both jaws will have a counter clockwise rotation and the chin points will advance. There will be a stretch of the soft tissues (skin, muscles) that will affect the gap but it is nothing compared to the advancement done by the actual gap.

The gap achieved by the osteotomy is more unstable. Some studies recommend not creating gaps larger than 7 mm with BSSO and recommend addressing those gaps by distraction osteogenesis.

But, actually, my last patient had gaps of 10 and 12 mm, and the one before last had 15 mm maps... I am really crossing my fingers.... it is way too much but there was no other way.

I believe that the use of custom designed and printed titanium plates can reduce the risk of complications to a minimum and, but there was no way I could use those with these last two patients.

hello, very nice to have a surgeon here. what do you have to say about the change in lips for a class II patient?
 
Consulting in person with the surgeon you decide, this is not like cooking a cake or buying a computer, for fuck's sake.
I got in touch with a surgeon these days, he is from a line that operates for aesthetics. For example, he told me he would do orthognathic work on this guy. He said he needed lol.

1601987169581


I talked to him a lot, but in summary it was this:

I have a big nose and a small china/jaw(not narrow). Although from the front it is not noticeable.
my mouth I notice that it projects forward in relation to the eyes.

I do some morphs only on the chin and nose and I think it looks already cool.

This doctor said I should do an orthognathic. I asked him if I had a smaller nose and a big chin / jaw if he would say the same. He said that he would undoubtedly notice, that the "segments are independent"


But the son of a bitch doesn't explain to me what exactly he would notice if that was the case. He said that it's not my nose that is big, but my jaw is retracted. So I sent that model to see what he would say

I wonder if he really knows something, or he just doesn't want to go back after I sent the assemblies and examples

cavill, for example, has a very strong and projected lower third, although the mouth is not super projected.

I showed this to this doctor. He was doing as if I didn't know what I'm talking about, that I'm talking nonsense and that he is seeing something that I'm not.

1601987799556



here are my morphs, I look very bad with the big nose and chin not projecting(ramus also), but in morphs, in my opinion, i may be wrong, it looks to me its same level as cavill or similar faces.

 

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Dr Sergio is it possible to do a visit with you? Im
Willing to sign NDA papers in case you want your identity kept secret
 
my fear of doing an orthognathic is to get a strange lip and nose. I already think I have this good.
 
@Sergio-OMS I have approx 11 mm overjet how much advancement would you guess I need to fix my problem?
 
Dr Sergio is it possible to do a visit with you? Im
Willing to sign NDA papers in case you want your identity kept secret

Why would I want my identity to be secret? It’s very public.
 
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Why would I want my identity to be secret? It’s very public.
I have no idea tbh Idk anything beside the fact that you are a surgeon and these kind of forums are not well seen.
So I thought you wanted privacy.

Seems im wrong ahaha gonna google up to see if i can take an appointment with you;
 
I got in touch with a surgeon these days, he is from a line that operates for aesthetics. For example, he told me he would do orthognathic work on this guy. He said he needed lol.

View attachment 714826

I talked to him a lot, but in summary it was this:

I have a big nose and a small china/jaw(not narrow). Although from the front it is not noticeable.
my mouth I notice that it projects forward in relation to the eyes.

I do some morphs only on the chin and nose and I think it looks already cool.

This doctor said I should do an orthognathic. I asked him if I had a smaller nose and a big chin / jaw if he would say the same. He said that he would undoubtedly notice, that the "segments are independent"


But the son of a bitch doesn't explain to me what exactly he would notice if that was the case. He said that it's not my nose that is big, but my jaw is retracted. So I sent that model to see what he would say

I wonder if he really knows something, or he just doesn't want to go back after I sent the assemblies and examples

cavill, for example, has a very strong and projected lower third, although the mouth is not super projected.

I showed this to this doctor. He was doing as if I didn't know what I'm talking about, that I'm talking nonsense and that he is seeing something that I'm not.

View attachment 714854


here are my morphs, I look very bad with the big nose and chin not projecting(ramus also), but in morphs, in my opinion, i may be wrong, it looks to me its same level as cavill or similar faces.


did he state what he would do on the first guy? :lul:
 
Depend on the surgeon,
Mine goes to 12-14 and i will get 12mm

I know a local surgeon who go 2cm

Alfaro also goes 2cm and even beyond
 
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Depend on the surgeon,
Mine goes to 12-14 and i will get 12mm

I know a local surgeon who go 2cm

Alfaro also goes 2cm and even beyond
wasnt there a paper which statet only up to 8mm its safe/stable (classic bsso)? :unsure:
 
5cm bsso or death
 
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wasnt there a paper which statet only up to 8mm its safe/stable (classic bsso)? :unsure:
bluepill surgeons are writing studies about their miserable skill while blackpill surgeon don't have time to write at all cuz they are busy operating subhuman jaws on daily basis
 
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bluepill surgeons are writing studies about their miserable skill while blackpill surgeon don't have time to write at all cuz they are busy operating subhuman jaws on daily basis
but how is it skill? isnt the problem the nerves who get stretched?
 
but how is it skill? isnt the problem the nerves who get stretched?
Not they don't know how to handle muscle pushing in the opposite direction , they suck
 
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Not they don't know how to handle muscle pushing in the opposite direction , they suck
how to handel it? and how you know if your surgeon is shit? :lul:
 
how to handel it? and how you know if your surgeon is shit? :lul:
if he tell you he cannot do ccw or more than 1cm he is bad surgeon
 
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I got in touch with a surgeon these days, he is from a line that operates for aesthetics. For example, he told me he would do orthognathic work on this guy. He said he needed lol.

View attachment 714826

I talked to him a lot, but in summary it was this:

I have a big nose and a small china/jaw(not narrow). Although from the front it is not noticeable.
my mouth I notice that it projects forward in relation to the eyes.

I do some morphs only on the chin and nose and I think it looks already cool.

This doctor said I should do an orthognathic. I asked him if I had a smaller nose and a big chin / jaw if he would say the same. He said that he would undoubtedly notice, that the "segments are independent"


But the son of a bitch doesn't explain to me what exactly he would notice if that was the case. He said that it's not my nose that is big, but my jaw is retracted. So I sent that model to see what he would say

I wonder if he really knows something, or he just doesn't want to go back after I sent the assemblies and examples

cavill, for example, has a very strong and projected lower third, although the mouth is not super projected.

I showed this to this doctor. He was doing as if I didn't know what I'm talking about, that I'm talking nonsense and that he is seeing something that I'm not.

View attachment 714854


here are my morphs, I look very bad with the big nose and chin not projecting(ramus also), but in morphs, in my opinion, i may be wrong, it looks to me its same level as cavill or similar faces.


What country/surgeon was it? Also did you end up doing anything?
 

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