I have 2 face photos and 2 photos of my CBCT scans. Should I get Bimax surgery or not?

[F_Wilks]

I apologize for the delayed response. Been hectic the past few days.

Ok but did the ortho say you don't even need to file down the teeth from the sides? How is he going to create the space? I guess if it's only the front tooth mainly he could do it without extractions.

No, he didn't. I asked about extractions, and he explained that the braces they use will actually widen your arch, creating more room to fit the teeth. I didn't mention jaw surgery during the consultation.

As for the lat ceph- I would not get it unless you're asked as it shows the same thing as the screenshot of the CBCT from the side. Also, that's kinda insane to me that he's charging you 400 for the files. Like, you already paid for the CBCT so how does it cost him to simply share the files with you? The files can usually be opened with free and publicly available software. You don't even need the medical software they use.

I didn't pay for the CBCT, it was complementary for the purpose of the free consultation. If I want to get my own copy, I have to pay.

As for the extraction for the jaw surgery, it really depends on what you want. Do you simply want to do a lefort 1 and BSSO and translate your jaw forward to create more volume? ( this might give you a slightly dogmaxxed appearance if overdone. I would be careful with excessive movements).

I agree about the danger of excessive movements, and I'm not sure exactly how much movement I want, but when I photograph myself in profile, there's a significant improvement in the appearance of my lower third whenever I'm "jutting" (i.e. pushing my jaw forwards as much as possible). It also improve my appearance in a 3/4 view. It fixes my recessed jaw and eliminates my mild "double chin", by stretching out the skin beneath my jaw.

I'm able to "jut" my lower jaw forwards exactly 6mm. Here is a link to "before/after" of myself jutting.

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Of course, if the upper jaw is also translated forwards, I imagine I'll need more than 6mm on the lower jaw.

Do you want to address your nasolabial angle? moving the upper jaw with lefort 1 can make your nasolabial angle less obtuse. I think there is some room for this. If the nasal framework and the infraorbital region are unchanged as with a non-modified lefort 1, it could shorten your philtrum.
Do you want to make your labiomental angle less deep? That can be done in various ways and is usually to do with the mentalis muscle and its attachment.

I'm not sure what I want for the nasolabial angle, I'd never thought of it. Wouldn't a downgraft necessarily lengthen my philtrum?

As for the labiomental angle, if you look at the "jutting" photos I linked above, you'll see my labiomental angle is very deep prior to jutting, but after jutting, it improves immensely. Would this effect be replicated by the BSSO?

Do you want to vertically lengthen your face? Your middle and lower thirds are similar but shorter than your upper third. What is your incisor show at normal smile (this also matters for stuff like downgrafting)

Here's 2 photos of myself smiling, both a normal smile and a "crazy person" smile. My smile is shaped more like a trapezoid than a crescent.

It's impossible for me to show the entirety of my upper incisors, even if I try to smile like a crazy person.

Normal smile versus exaggerated smile

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On the whole, in the absence of medical indications, you should have strong reasons to do jaw surgery for aesthetic reasons- that is, a clear goal of what you dislike and want changed.The osteotomy in BSSO is performed in close proximity to the inferior alveolar nerve (IAN), and thus IAN damage often results. The incidence of IAN deficits after mandibular osteotomies varies from 0% to 100%. Deficits include numbness or unusual sensations in the lower lip, chin, teeth, and gingiva. There is also a 5-10% chance of a permanently runny nose/ chronic sinusitus. Honestly, there is like several pages worth of post operative complications and not all of them can be reversed. This isn't to say you shouldn't pursue surgery, but I wouldn't move everything unecessarily. Sometimes, singular jaw movements etc. can achieve the desired result.

I'm already convinced that I'd benefit from the advancement of the lower jaw. What do you think about advancement/downgraft of the upper jaw?

I'd love to eliminate my "trapezoid smile", and have a "crescent shaped" smile that's shaped the same as everybody else. I'd 100% go for a downgraft to fix my smile.

Do I have a similar situation to the guy in this picture below? He had a downgraft. Here's a link to the Youtube video.