How to properly plan jaw surgery (DJS, trimax, orthogonatic)

[gravlek]

No, not in my case. My upper jaw was pretty retruded relative to cranial base so it worked out well. I was very clear when consulting with surgeons that overadvancment was a major concern for me so it was factored into planning.

You already had surgery? How come you’re still on this site man? You should be out slaying/enjoying

 

[czechpsl]

About 125/126 rn. So I would definitely benefit from a gonial angle lowering bsso.

I was originally planning on getting Ramieris ramus widening cut, but knowing that he offers ramus lengthening cut is interesting too.
I wonder if he can lengthen and widen the ramus at the same time? I know he doesn’t do what he isn’t comfortable doing.

Yeah, I'm very similar to you—I'd benefit from both, but sadly, doing both at the same time is impossible. Widening is done by rotating the proximal segment, which contains the gonion, but if you include the gonion in the distal segment, you can't widen it. If I had to choose between widening or lowering the gonions, I'd choose lengthening. Widening can cause condylar resorption, the results are very underwhelming, and it makes you look bloated because it widens the whole ramus (not just the gonions)

 

[gravlek]

Yeah, I'm very similar to you—I'd benefit from both, but sadly, doing both at the same time is impossible. Widening is done by rotating the proximal segment, which contains the gonion, but if you include the gonion in the distal segment, you can't widen it. If I had to choose between widening or lowering the gonions, I'd choose lengthening. Widening can cause condylar resorption, the results are very underwhelming, and it makes you look bloated because it widens the whole ramus (not just the gonions)

Check this https://looksmax.org/threads/ramus-widening-on-condyle-axis.1367155/

Looks lower, but could be the beard

 

[Gittes]

You already had surgery? How come you’re still on this site man? You should be out slaying/enjoying

Bimax at least in my case was a normalization surgery. It doesn't necessarily make you much better looking unless you are an extreme SFS case with vertically deficient maxilla and mandible + I genuinely enjoy discussions about bimax on here.

 

[Gittes]

Do you know what your SNA was before surgery?

I can't find it right now. I will try and find ceph tracing which I had done pre-op later.

 

[gravlek]

Bimax at least in my case was a normalization surgery. It doesn't necessarily make you much better looking unless you are an extreme SFS case with vertically deficient maxilla and mandible

I’m aware, for most its even a meme surgery as it doesn’t meaningfully change their face and yet they treat it like the solution to all their misery. How come you didn’t get more done? You seem knowledgeable enough to achieve great surgical results

+ I genuinely enjoy discussions about bimax on here.

That’s cool too

 

[Gittes]

I’m aware, for most its even a meme surgery as it doesn’t meaningfully change their face and yet they treat it like the solution to all their misery. How come you didn’t get more done? You seem knowledgeable enough to achieve great surgical results

My surgery journey isn't quite finished yet. I'll still need to deal with alar base widening from LF1 advancement as well as address upper maxillary recession.

My surgical plan for bimax was pretty conservative because any any more advancement beyond 5mm would have been detrimental in my case.

 

[czechpsl]

Check this https://looksmax.org/threads/ramus-widening-on-condyle-axis.1367155/

Looks lower, but could be the beard

www.tiktok.com/@dr_maxilloroma/video/7603288192183176480

Look at this, he says it right there, but in that thread, the ramus is still the same height. He had a normal to slightly shorter ramus, and when it was widened, it became more defined, so it looks longer. And as I said, it's impossible to widen the angles via condylar torque when the gonion isn't in the condylar segment. I'm quite bullish on post-gonial BSSO because I think I might be able to avoid dehiscence, which happens almost every time with drop-down implants

 

[czechpsl]

www.tiktok.com/@dr_maxilloroma/video/7603288192183176480

Look at this, he says it right there, but in that thread, the ramus is still the same height. He had a normal to slightly shorter ramus, and when it was widened, it became more defined, so it looks longer. And as I said, it's impossible to widen the angles via condylar torque when the gonion isn't in the condylar segment. I'm quite bullish on post-gonial BSSO because I think I might be able to avoid dehiscence, which happens almost every time with drop-down implants

Kinda funny how he talks about implants like he invented them

 

[gravlek]

My surgery journey isn't quite finished yet. I'll still need to deal with alar base widening from LF1 advancement as well as address upper maxillary recession.

So alar base reduction + infra's is what you're eyeing for now? Wouldn't all at once have been more a ideal scenario?

My surgical plan for bimax was pretty conservative because any any more advancement beyond 5mm would have been detrimental in my case.

What did you address mainly with your bimax? Downgrowth?

 

[gravlek]

Kinda funny how he talks about implants like he invented them

He's not only a surgeon but also a salesman clearly

 

[czechpsl]

He's not only a surgeon but also a salesman clearly

Would you do surgery first or decomp braces before?

 

[Usurper]

Would you do surgery first or decomp braces before?

How does surgery work without adequate decomp previously? Sounds like a recipe for more issues, as you need to predict post-op-ortho and potentially bite won't work after surgery at all? + the whole operation room surgeon making sure everything is seated etc

 

[gravlek]

Would you do surgery first or decomp braces before?

Im actually considering a marpe first, so that would logically be followed by decomposition braces before surgery

 

[czechpsl]

How does surgery work without adequate decomp previously? Sounds like a recipe for more issues, as you need to predict post-op-ortho and potentially bite won't work after surgery at all? + the whole operation room surgeon making sure everything is seated etc

It has its own indications—if you need both jaws to advance without any rotation, have a skeletal Class 1 with nothing to decompensate, or if someone has sleep apnea, can't tolerate braces, and needs relief, surgery-first is always the choice

 

[ScientiaAeterna]

You know what I mean tho bro, I’m talking about their approach to surgery. They think simply getting a procedure will ascend them, whereas men recognise the need to actually dissect the whole thing and make sure the outcome/result is optimised through an optimal surgical plan

Becouse men aesthetic are way more complex then women’s

 

[Usurper]

Becouse men aesthetic are way more complex then women’s

Not really true, it's just the tendency to overrate women looks.

 

[ScientiaAeterna]

Not really true, it's just the tendency to overrate women looks.

It is true. “tendency” is %, which shapes reality. It’s shaped by most people options. Without studying deeply aesthetics, ain’t no man which is gonna naturally judge aesthetics at the lever foids do biologically.
Remember that true eve is just a man with long hairs.
I’m not saying it’s been always like that tho. If you study ancient (before civilization And domestication arrived) skull they are so fucking masculine and even women looked 500% times more masculine then now on a avarage. That’s facts

 

[Gittes]

So alar base reduction + infra's is what you're eyeing for now? Wouldn't all at once have been more an ideal scenario?

Yes, it would have been more convenient but I always planned on getting my plates removed post OP so I’ll be doing it then.

I decided it would be better to address these points once swelling had fully dissipated and I know exactly where I stand.

What did you address mainly with your bimax? Downgrowth?

Opposite of downward growth. My maxilla was vertically deficient + underbite.

 

[czechpsl]

My maxilla was vertically deficient + underbite

Do you at least have a mogger mandible?

 

[gravlek]

Yes, it would have been more convenient but I always planned on getting my plates removed post OP so I’ll be doing it then.

Why do you want to get your plates removed?

 

[Gittes]

Do you at least have a mogger mandible?

Above average but I would not regard it as "mogger"!
Bimax doesn't really give you angularity unless you have wide gonions and a weak mandible.

 

[Gittes]

Why do you want to get your plates removed?

Personal preference really. I don't like the idea of having a foreign body in my skull. Yes, it's irrational, especially if you're considering implants but at least they can be removed easily.

 

[vermicel]

Remember that true eve is just a man with long hairs.

 

[HenryLang182]

Check this https://looksmax.org/threads/ramus-widening-on-condyle-axis.1367155/

Looks lower, but could be the beard

This was widening right? Can implants be used once the bone is healed so you can make the gonion wider or the ramus longer after the bimax?

 

[HenryLang182]

Yeah, I'm very similar to you—I'd benefit from both, but sadly, doing both at the same time is impossible. Widening is done by rotating the proximal segment, which contains the gonion, but if you include the gonion in the distal segment, you can't widen it. If I had to choose between widening or lowering the gonions, I'd choose lengthening. Widening can cause condylar resorption, the results are very underwhelming, and it makes you look bloated because it widens the whole ramus (not just the gonions)

Do you think is better lengthening than widening the gonions? maybe doesn't look bloated if you have a narrow jaw, i think he looks better and doesn't look bloated in this example.

Do you think that lengthening the ramus would have been better than widening for him?

Is better Aestheticly to have longer ramus or wider gonions? Which is the best if you have to choose?

 

[HenryLang182]

Yeah, I'm very similar to you—I'd benefit from both, but sadly, doing both at the same time is impossible. Widening is done by rotating the proximal segment, which contains the gonion, but if you include the gonion in the distal segment, you can't widen it. If I had to choose between widening or lowering the gonions, I'd choose lengthening. Widening can cause condylar resorption, the results are very underwhelming, and it makes you look bloated because it widens the whole ramus (not just the gonions)

I believe this guy had widening, it wasn't a lot but I believe he looks more defined in the front, although I don't know if it is because he had chin downgrafting making the chin more lower and longer, im not sure about that, but if the widening helps like this I think is looks very nice.

 

[czechpsl]

Do you think is better lengthening than widening the gonions? maybe doesn't look bloated if you have a narrow jaw, i think he looks better and doesn't look bloated in this example.

Do you think that lengthening the ramus would have been better than widening for him?

Is better Aestheticly to have longer ramus or wider gonions? Which is the best if you have to choose?

Yeah, he looks better, no doubt, but I couldn’t find this picture on his IG. I guess it was really condylar torque, but it could possibly be jaw angles. The decision between lengthening or widening depends on your starting point. But if someone needs both, I would say lengthening is better (from what I have seen, it doesn’t risk dehiscence), and then maybe put implants in just for width. For the front profile, it’s definitely better to have a wider jaw than lower gonions, but for 3/4 and side profile, a lower ramus is law

 

[czechpsl]

I believe this guy had widening, it wasn't a lot but I believe he looks more defined in the front, although I don't know if it is because he had chin downgrafting making the chin more lower and longer, im not sure about that, but if the widening helps like this I think is looks very nice.

He had a long ramus, so it was simple for him

 

[HenryLang182]

Yeah, he looks better, no doubt, but I couldn’t find this picture on his IG. I guess it was really condylar torque, but it could possibly be jaw angles. The decision between lengthening or widening depends on your starting point. But if someone needs both, I would say lengthening is better (from what I have seen, it doesn’t risk dehiscence), and then maybe put implants in just for width. For the front profile, it’s definitely better to have a wider jaw than lower gonions, but for 3/4 and side profile, a lower ramus is law

Maybe he is in a Ramieri old posts, i belive it was condylar torque because he didn't mention implants or anything.

Thats a good point maybe later you can use implants to widen or filler.

Isnt there an implant that can address both?
Making the gonions wider and also lengthening the ramus?

 

[czechpsl]

he looks better and doesn't look bloated

Look at this result. It looks very underwhelming, maybe even worse. youtube.com/shorts/oWBTborbsW8

 

[czechpsl]

Isnt there an implant that can address both?
Making the gonions wider and also lengthening the ramus?

Of course there is, but you will most likely have a lot of dehiscence

 

[HenryLang182]

Look at this result. It looks very underwhelming, maybe even worse. youtube.com/shorts/oWBTborbsW8

I agree in this case

 

[HenryLang182]

Of course there is, but you will most likely have a lot of dehiscence

Dehisence can only happen recently after the surgery or can happen months or even years later in this cases?

 

[gravlek]

Yeah, he looks better, no doubt, but I couldn’t find this picture on his IG. I guess it was really condylar torque, but it could possibly be jaw angles. The decision between lengthening or widening depends on your starting point. But if someone needs both, I would say lengthening is better (from what I have seen, it doesn’t risk dehiscence), and then maybe put implants in just for width. For the front profile, it’s definitely better to have a wider jaw than lower gonions, but for 3/4 and side profile, a lower ramus is law

his thread is here https://looksmax.org/threads/trimax-gymmaxx-leanmaxx-ascension.1654210/

 

[HenryLang182]

Look at this result. It looks very underwhelming, maybe even worse. youtube.com/shorts/oWBTborbsW8

But widening in other cases look better i dont know the reason

 

[czechpsl]

Dehisence can only happen recently after the surgery or can happen months or even years later in this cases?

Right after. Like, the muscle isn't at the bottom of the implant, so the lowest part of the jaw is skin and implants instead of bone, muscle, and skin. Maybe you can do some reconstruction after, but I don't know

 

[czechpsl]

But widening in other cases look better i dont know the reason

I saw a thread criticizing condylar torque, saying that it looks bad and added a lot of width on the ramus above the gonion, but I can't find that thread—maybe it got deleted, I don't know