LeFort 1 impaction CCW + Mandibular autorotation + Genioplasty DOWNWARD-GROWNCELS GTFIH!!!

[yorker12]

So, I have finished healing and orthodontics for SARPE.

From the start I discussed genioplasty with my surgeon (he recommended waiting untill i am done with the expansion and for my jaws to stabilize before doing it), but after SARPE i also wanted to get rid of my gummy smile and get a better profile view. So my surgeon suggested getting 3-4mm LF1 impaction with CCW + genioplasty. I asked a couple of times if I will require BSSO, he said no, that my lower jaw is not recessed, only my chin. Other than my gummy smile, my bite is now class 1, but i don't know how camouflaged it is.

His reasoning is that with impaction + CCW my lower jaw will autorotate which will increase projection + genioplasty for desired chin position.

So I have 2 questions:
1) Should I still push for double jaw or stick with my surgeons recommendation. He says I have good occlusion atm. Face outline below(THIS IS PRE-SARPE AND ORTHODONTICS, I WILL GET NEW SCANS NEXT MONTH).
2) There don't seem to be a lot of single jaw autorotation before/afters, do any of you have more examples of this? I will post the ones I found here.

Below is my pre SARPE outline(idk what this kind of drawing is called)

I showed this to my surgeon because i have a somewhat similar base and he said this is achievable for my case(he also commented that my situation is worse than this guys so the change would be more noticeable JFL). This guy had LF1 impaction + ccw + genioplasty:

Then there is this woman who got LF1 impaction, mandible autorotation + genioplasty. But she got unlucky and got condylar resorption which made her relapse (but even then the post relapse version looks better than the initial picture):

Have any of you done something similar?

EDIT: PEOPLE SEEM TO BE CONFUSED WITH THE CONCEPT OF MANDIBULAR AUTOROTATION. Your lower jaw can rotate and and advance forward as a result of maxillary impaction to accomodate the new bite.

Here are a couple of resources/info:

The inter-relationship between mandibular autorotation and maxillary LeFort I impaction osteotomies - PubMed

The purposes of the present investigation were to: 1)locate the instantaneous rotation center of mandible autorotation during maxillary surgical impaction; 2) identify the discrepancies between the resultant mandibular position following by maxillary surgical impaction and presurgical...

pubmed.ncbi.nlm.nih.gov

https://www.sciencedirect.com/science/article/abs/pii/0002941682900355

https://progressinorthodontics.springeropen.com/articles/10.1186/s40510-018-0213-5 (non surgical impaction, this one is with TAD's)

 

[Deleted member 2729]

Wtf is autorotation supposed to be, your mandible is gonna cut itself in half?

 

[AscendingHero]

So, I have finished healing and orthodontics for SARPE.

From the start I discussed genioplasty with my surgeon (he recommended waiting untill i am done with the expansion and for my jaws to stabilize before doing it), but after SARPE i also wanted to get rid of my gummy smile and get a better profile view. So my surgeon suggested getting 3-4mm LF1 impaction with CCW + genioplasty. I asked a couple of times if I will require BSSO, he said no, that my lower jaw is not recessed, only my chin. Other than my gummy smile, my bite is now class 1, but i don't know how camouflaged it is.

His reasoning is that with impaction + CCW my lower jaw will autorotate which will increase projection + genioplasty for desired chin position.

So I have 2 questions:
1) Should I still push for double jaw or stick with my surgeons recommendation. He says I have good occlusion atm. Face outline below(THIS IS PRE-SARPE AND ORTHODONTICS, I WILL GET NEW SCANS NEXT MONTH).
2) There don't seem to be a lot of single jaw autorotation before/afters, do any of you have more examples of this? I will post the ones I found here.

Below is my pre SARPE outline(idk what this kind of drawing is called)
View attachment 1684389

I showed this to my surgeon because i have a somewhat similar base and he said this is achievable for my case(he also commented that my situation is worse than this guys so the change would be more noticeable JFL). This guy had LF1 impaction + ccw + genioplasty:

View attachment 1684394

Then there is this woman who got LF1 impaction, mandible autorotation + genioplasty. But she got unlucky and got condylar resorption which made her relapse (but even then the post relapse version looks better than the initial picture):
View attachment 1684400

Have any of you done something similar?

What is mandibular autorotation? how is it done/how does it work, how does it? cost? is it even a surgical procedure, etc?

 

[yorker12]

Wtf is autorotation supposed to be, your mandible is gonna cut itself in half?

So, when you shorten the maxilla, your lower jaw will move forwards & upwards to connect the new occlusion. The ratio of impaction to autorotation movement was almost 1:1 in some cases.

You can educate yourself more with these:

The inter-relationship between mandibular autorotation and maxillary LeFort I impaction osteotomies - PubMed

The purposes of the present investigation were to: 1)locate the instantaneous rotation center of mandible autorotation during maxillary surgical impaction; 2) identify the discrepancies between the resultant mandibular position following by maxillary surgical impaction and presurgical...

pubmed.ncbi.nlm.nih.gov

 

[Deleted member 16371]

Just get double jaw. Downward growth isn’t a big deal. What’s the angle?

 

[yorker12]

Just get double jaw. Downward growth isn’t a big deal. What’s the angle?

If I can get the results from the first case, I would be satisfied, also the price is extremely cheap(under 7k).

I would probably have to find a different surgeon out of country & pay more.

What could I say to convince my surgeon for double jaw surgery? That I am gonna LDAR otherwise?


What do you mean by angle? My gonial angle seems to be 121-122 degress. I have no idea about the planned rotation or occlusion angle yet, I have a consultation with my surgeon next month, I just want to educate myself as much as possible before meeting him again.

 

[yorker12]

What is mandibular autorotation? how is it done/how does it work, how does it? cost? is it even a surgical procedure, etc?

Check the edit, there are some sources for info. Autorotation can be achieved with LF1 impaction.

 

[AscendingHero]

So, when you shorten the maxilla, your lower jaw will move forwards & upwards to connect the new occlusion. The ratio of impaction to autorotation movement was almost 1:1 in some cases.

You can educate yourself more with these:

The inter-relationship between mandibular autorotation and maxillary LeFort I impaction osteotomies - PubMed

The purposes of the present investigation were to: 1)locate the instantaneous rotation center of mandible autorotation during maxillary surgical impaction; 2) identify the discrepancies between the resultant mandibular position following by maxillary surgical impaction and presurgical...

pubmed.ncbi.nlm.nih.gov

@thagangsta (@Babushkacatlady ) talked about this extensively on the TGW forum

I'd suggest reading the Essentials to Facial Growth by Enlow

 

[St.TikTokcel]

From "it never began" to "it's over". No, thank you. I'm not getting my mandible sliced in half. Also, there could be chance that it would get botched.

 

[poopmaster22]

Damn you’d fuck who is your surgeon? Unless it is local then don’t tell

 

[Deleted member 2729]

So, I have finished healing and orthodontics for SARPE.

From the start I discussed genioplasty with my surgeon (he recommended waiting untill i am done with the expansion and for my jaws to stabilize before doing it), but after SARPE i also wanted to get rid of my gummy smile and get a better profile view. So my surgeon suggested getting 3-4mm LF1 impaction with CCW + genioplasty. I asked a couple of times if I will require BSSO, he said no, that my lower jaw is not recessed, only my chin. Other than my gummy smile, my bite is now class 1, but i don't know how camouflaged it is.

His reasoning is that with impaction + CCW my lower jaw will autorotate which will increase projection + genioplasty for desired chin position.

So I have 2 questions:
1) Should I still push for double jaw or stick with my surgeons recommendation. He says I have good occlusion atm. Face outline below(THIS IS PRE-SARPE AND ORTHODONTICS, I WILL GET NEW SCANS NEXT MONTH).
2) There don't seem to be a lot of single jaw autorotation before/afters, do any of you have more examples of this? I will post the ones I found here.

Below is my pre SARPE outline(idk what this kind of drawing is called)
View attachment 1684389

I showed this to my surgeon because i have a somewhat similar base and he said this is achievable for my case(he also commented that my situation is worse than this guys so the change would be more noticeable JFL). This guy had LF1 impaction + ccw + genioplasty:

View attachment 1684394

Then there is this woman who got LF1 impaction, mandible autorotation + genioplasty. But she got unlucky and got condylar resorption which made her relapse (but even then the post relapse version looks better than the initial picture):
View attachment 1684400

Have any of you done something similar?

EDIT: PEOPLE SEEM TO BE CONFUSED WITH THE CONCEPT OF MANDIBULAR AUTOROTATION. Your lower jaw can rotate and and advance forward as a result of maxillary impaction to accomodate the new bite.

Here are a couple of resources/info:

The inter-relationship between mandibular autorotation and maxillary LeFort I impaction osteotomies - PubMed

The purposes of the present investigation were to: 1)locate the instantaneous rotation center of mandible autorotation during maxillary surgical impaction; 2) identify the discrepancies between the resultant mandibular position following by maxillary surgical impaction and presurgical...

pubmed.ncbi.nlm.nih.gov

https://www.sciencedirect.com/science/article/abs/pii/0002941682900355

https://progressinorthodontics.springeropen.com/articles/10.1186/s40510-018-0213-5 (non surgical impaction, this one is with TAD's)

why do all well known surgeon perform ccw bimax then and not only ccw lefort

 

[LebenistneHure]

If I can get the results from the first case, I would be satisfied, also the price is extremely cheap(under 7k).

I would probably have to find a different surgeon out of country & pay more.

What could I say to convince my surgeon for double jaw surgery? That I am gonna LDAR otherwise?


What do you mean by angle? My gonial angle seems to be 121-122 degress. I have no idea about the planned rotation or occlusion angle yet, I have a consultation with my surgeon next month, I just want to educate myself as much as possible before meeting him again.

What country? You can PM me if you want, I'm looking into getting jaw surgery for a long face as well. Also, the guy who had a CCW lefort1 impaction, and genio, do you notice how his nostrils seem to be less prominent in the after? Did your surgeon comment on that, or did you perhaps ask him about it? I'm trying to figure out if his nasal base went up slightly by fixing the underlying facial structure.

 

[Deleted member 9405]

I showed this to my surgeon because i have a somewhat similar base and he said this is achievable for my case(he also commented that my situation is worse than this guys so the change would be more noticeable JFL). This guy had LF1 impaction + ccw + genioplasty:

View attachment 1684394

You gotta understand nobody will make impaction this way, this is some new technique presented in this paper as example of new procedure. Lf1 impaction limit depends on you teeth roots ends to nasal airway. I have read that study months ago but its not feasable for your surgeon to copy others work from paper and do it in practice. I had to have 3-4mm impaction but got 2mm because of this limitation so im sorry to break it to you.

Study link for others

 

[Cristiano88]

What country are you in OP?
I am also from Eastern Europe.

 

[yorker12]

From "it never began" to "it's over". No, thank you. I'm not getting my mandible sliced in half. Also, there could be chance that it would get botched.

No mandible cut, only maxillary impaction + genioplasty. I was worried about it getting botched, but the stability and predictability of jaw surgery if there is no BSSO involved seems very high.

 

[yorker12]

Damn you’d fuck who is your surgeon? Unless it is local then don’t tell

Local, but he has been metioned on lookism. Some have been to him iirc, easter european surgeon.

 

[yorker12]

why do all well known surgeon perform ccw bimax then and not only ccw lefort

Because in a lot of the cases single a single jaw movement is not enough.

As you can see from the ceph, my gonial angle is not bad and lower lip is not setback compared to my upper lip, my condyles are adequate size also my bite is borderline class 1/2, so there is no functional need for mandibular advancement. I do not fit the criteria. Aesthetically speaking, it might be worth it, but the potential risks and complications drastically increase with BSSO.

TLDR: My surgeon said in my case there is no need for BSSO.

 

[yorker12]

What country? You can PM me if you want, I'm looking into getting jaw surgery for a long face as well. Also, the guy who had a CCW lefort1 impaction, and genio, do you notice how his nostrils seem to be less prominent in the after? Did your surgeon comment on that, or did you perhaps ask him about it? I'm trying to figure out if his nasal base went up slightly by fixing the underlying facial structure.

Lefort impaction typically widens the alar base. There were 2 options of sewing the lip shut one of which increased the alar base width by like 10% while the other option only by like <5%.

From what ive seen the nostrils will widen and the nose might upturn (can be negated with shaving of some part of the nasal bone, dont remember what), but the overall airway volume might suffer from impaction. There was one study which showed that paradoxically breathing for patients became subjectively better because of the increased nasal width. So the airway was smaller, but the nose is wider = feels easier to breathe.

 

[Deleted member 2729]

Because in a lot of the cases single a single jaw movement is not enough.

As you can see from the ceph, my gonial angle is not bad and lower lip is not setback compared to my upper lip, my condyles are adequate size also my bite is borderline class 1/2, so there is no functional need for mandibular advancement. I do not fit the criteria. Aesthetically speaking, it might be worth it, but the potential risks and complications drastically increase with BSSO.

TLDR: My surgeon said in my case there is no need for BSSO.

Bro can you give me surgery advice?

 

[yorker12]

You gotta understand nobody will make impaction this way, this is some new technique presented in this paper as example of new procedure. Lf1 impaction limit depends on you teeth roots ends to nasal airway. I have read that study months ago but its not feasable for your surgeon to copy others work from paper and do it in practice. I had to have 3-4mm impaction but got 2mm because of this limitation so im sorry to break it to you.

Study link for others

This is by no means a "new" procedure, the horseshoe osteotomy has been around since the 80's

I asked my surgeon about this when showing him the study, he also does a lot of dental implant work, so he is well versed in the technique, but he said in my case a regular lefort will be good enough.

Hard to say before i see my 3d plans.

It is true that impaction is limited by the airway and teeth roots, but i have vertical maxillary excess AKA gummy smile.
But it is really individual, each person will differ on how much movement they can have. If the movement is too big, they can also shave the back part of the maxilla/cheekbone(forgot the name of it).

So for your case either your surgeon was lazy (or smart tbh) and didn't want to take extra risks with shaving the bones or you just got a bad end of the straw and physically could not have the needed amount of impaction.

 

[yorker12]

Bro can you give me surgery advice?

I have researched this shit with autistic dedication. I can help you if your case is similar to mine or similar procedures/movements, shoot me a pm.

 

[yorker12]

What country are you in OP?
I am also from Eastern Europe.

pm

 

[Deleted member 17429]

From "it never began" to "it's over". No, thank you. I'm not getting my mandible sliced in half. Also, there could be chance that it would get botched.

Shut the fuck up.
Improvement is improvement
Don’t give up, never ldar

 

[St.TikTokcel]

Shut the fuck up.
Improvement is improvement
Don’t give up, never ldar