Rate my bimax plan (why does maxilla look weird?)

[brock]

CCW (forgot degrees)
High cut segmental lefort 1
Mandible: 10cm
Overall chin advancement: 15mm
Widening: 4mm each side

Here is the bone:


And before after:



Why does my maxilla look recessed in the after and how do I fix it?

Surgeon recommended normal lefort 1 instead of high cut and zygo + paranasal implants to compensate.

I wonder if less CCW and more linear advancement would also fix this.

Full album: imgur

@RealSurgerymax

 

[HarrierDuBois]

Your midface and infras are recessed, you either need a lefort II or implants. I would suggest infraorbital implants and midface implants.

 

[Drixzy]

ITS SO OVER

 

[hansmoleman]

What are you doing orthodontically?

 

[Deleted member 1901]

Why does my maxilla look recessed in the after and how do I fix it?

Because you need lefort 3

 

[HarrierDuBois]

Because you need lefort 3

We haven't seen his 3/4, 2 might be enough but if it's too fucked then yes 3.

 

[Deleted member 43403]

holy fuck i would have committed if i was you.

 

[Deleted member 43403]

We haven't seen his 3/4, 2 might be enough but if it's too fucked then yes 3.

what do you rate the young drago in my avi i dug these photos from facebook

 

[HarrierDuBois]

what do you rate the young drago in my avi i dug these photos from facebook

Looks like a morph in those runway photos.

 

[brock]

We haven't seen his 3/4, 2 might be enough but if it's too fucked then yes 3.

3/4 in the album:

I don’t look that recessed in the maxilla irl. It’s the anteface jawline that makes it look recessed.

Your midface and infras are recessed, you either need a lefort II or implants. I would suggest infraorbital implants and midface implants.

That’s the plan, yes. I need to decide the bone movements before implants.

 

[HarrierDuBois]

3/4 in the album:

I don’t look that recessed in the maxilla irl. It’s the anteface jawline that makes it look recessed.

That’s the plan, yes. I need to decide the bone movements before implants.

Ok lefort 3.

 

[longjohnmong]

So you asked specifically for high Lefort? Because paranasal deficiency?

 

[brock]

So you asked specifically for high Lefort? Because paranasal deficiency?

No, that’s what was recommended to me initially

 

[longjohnmong]

No, that’s what was recommended to me initially

But now he's recommending regular?

 

[Lebgfinal]

send REAL FACE
no comptuer grneraterd ujmage

 

[brock]

But now he's recommending regular?

When I brought up the fact that the maxilla looks weird in the simulation, he said he could augment with midface implants.

However, he said due to the high cut lefort, he wouldn’t be able to properly place implants in the paranasal region. Hence I would have to sacrifice the high cut in order to get implants.

send REAL FACE
no comptuer grneraterd ujmage

lol not gonna get doxxed

 

[brock]

What are you doing orthodontically?

Don’t know, orthodontics will be post op.

Ok lefort 3.

Lol what happened to implants?

 

[hansmoleman]

What are you doing orthodontically?

@brock

 

[hansmoleman]

Don’t know, orthodontics will be post op.

Lol what happened to implants?

Oh, got it. But how is this possible? You seem to have skeletal class 2, shouldn’t you need some decompensation?

 

[brock]

Oh, got it. But how is this possible? You seem to have skeletal class 2, shouldn’t you need some decompensation?

I don’t know. I assume they can do whatever is necessary afterwards.

 

[hansmoleman]

I don’t know. I assume they can do whatever is necessary afterwards.

Who is your surgeon? Surgery first is not typically indicated for class 2

 

[longjohnmong]

When I brought up the fact that the maxilla looks weird in the simulation, he said he could augment with midface implants.

I see. My paranasal area was really sunken in prior to bimax. Now it's the exact opposite, and I just had regular Lefort. I'm most swollen in that area, 2 weeks post op, but it's hard for me to imagine that it's going to completely reverse.

Also, yeah, the soft tissue simulation didn't predict any change to that area. Here's my after:

Even my nostrils got pushed forward, like the rear part of my nostril is now closer to the tip of my nose.

 

[brock]

Who is your surgeon? Surgery first is not typically indicated for class 2

Surgeon is Safi (check my previous thread).

Are you sure I'm still a class 2? I had braces as a teen. The jaws are moving in unison, so I don't think occlusion will change much. In fact, he's surgically correcting some minor occlusion (plus 4mm widening of the maxilla).

 

[brock]

I see. My paranasal area was really sunken in prior to bimax. Now it's the exact opposite, and I just had regular Lefort. I'm most swollen in that area, 2 weeks post op, but it's hard for me to imagine that it's going to completely reverse.

Also, yeah, the soft tissue simulation didn't predict any change to that area. Here's my after:

View attachment 2445321

Even my nostrils got pushed forward, like the rear part of my nostril is now closer to the tip of my nose.

Hmm yeah, it shows a similar recessed maxilla for you. Maybe the simulation is just bad.

Did you get downgrafting or advancement of the maxilla? Or just CCW? Most of my advancement is coming from CCW.

 

[Deleted member 18582]

Almost everyone I’ve asked who has done this has said they looked more sunken in in the 3d simulation than they did in real life after their operation, especially the maxilla. I would ask Safi what he thinks about how accurate these simulations are.

 

[longjohnmong]

Hmm yeah, it shows a similar recessed maxilla for you. Maybe the simulation is just bad.

Did you get downgrafting or advancement of the maxilla? Or just CCW? Most of my advancement is coming from CCW.

Maxilla was advanced linearly 3mm, 7.6mm total. 8.5 degrees CCW rotation about the ANS.

When I saw my simulation I was filled with a sense of dread, but I decided to just ignore it.

 

[hansmoleman]

Surgeon is Safi (check my previous thread).

Are you sure I'm still a class 2? I had braces as a teen. The jaws are moving in unison, so I don't think occlusion will change much. In fact, he's surgically correcting some minor occlusion (plus 4mm widening of the maxilla).

I’m not sure, no. How are your front lower teeth? Are they straight or proclined?

 

[brock]

Maxilla was advanced linearly 3mm, 7.6mm total. 8.5 degrees CCW rotation about the ANS.

When I saw my simulation I was filled with a sense of dread, but I decided to just ignore it.

Bruh, same feeling rn

I don't think it can look worse though, and the functional improvements alone would be worth it to me.

I’m not sure, no. How are your front lower teeth? Are they straight or proclined?

Lower teeth? Pretty straight I think. I have a permanent retainer in place.

 

[longjohnmong]

I don't think it can look worse though

Yeah, that made it easy for me. I basically had nothing to lose.

 

[Deleted member 40986]

Its over from the base

 

[aestheticmax]

Honestly I think that your maxilla looks good in the after simulation, if you are unsure ask the surgeon if he can make another simulation with normal lefort to compare also a version with less ccw and more linear advancement. I also think that implants can make a very big difference in the result. When will you see your implant design?

 

[brock]

Ok, I got the first implant designs.




Some info:

• Adding 3.6mm projection to cheekbone
• Raising infraorbital by 1mm
• Bigonial to bizygomatic is 95%
• Jaw widened by 12mm
• Ramus extended by 8mm
• Gonial angle from 119º to 109º
• Midface/paranasal implants will be shaped from cartilage during surgery
• Chin will be widened with genio (can't be simulated)

They also did a soft tissue simulation including the implants. Before is osteotomy only, after is osteo + implants:








Some thoughts:

• Looks too square, maybe I need to not change the ramus or gonial angle
• Too apple cheeked, should I raise the zygos?

 

[its_over]

Ok, I got the first implant designs.




Some info:

• Adding 3.6mm projection to cheekbone
• Raising infraorbital by 1mm
• Bigonial to bizygomatic is 95%
• Jaw widened by 12mm
• Ramus extended by 8mm
• Gonial angle from 119º to 109º
• Midface/paranasal implants will be shaped from cartilage during surgery
• Chin will be widened with genio (can't be simulated)

They also did a soft tissue simulation including the implants. Before is osteotomy only, after is osteo + implants:








Some thoughts:

• Looks too square, maybe I need to not change the ramus or gonial angle
• Too apple cheeked, should I raise the zygos?

I have a friend that has your same after bimax jaw and it looks weird. No chin projection and when u bloat u’ll look like a chipmunk

 

[hansmoleman]

How are you changing the ramus? “Vanilla” BSSO doesn’t really change them right?

 

[brock]

I have a friend that has your same after bimax jaw and it looks weird. No chin projection and when u bloat u’ll look like a chipmunk

No chin projection as in forward or downward? Keep in mind that this doesn't show the forehead and my face is on the narrow side.

How are you changing the ramus? “Vanilla” BSSO doesn’t really change them right?

Not actually changing the bone. The implant extends down to appear like a longer ramus.

 

[PlagiocephalyTypeIV]

Are the infraorbital implants and paranasal augmentation two separate prices or do they count as “midface implant” ?

 

[brock]

Are the infraorbital implants and paranasal augmentation two separate prices or do they count as “midface implant” ?

What's shown in the design is infra + zygo. The paranasal will be done separately by hand.

 

[hansmoleman]

No chin projection as in forward or downward? Keep in mind that this doesn't show the forehead and my face is on the narrow side.

Not actually changing the bone. The implant extends down to appear like a longer ramus.

Mm ok but you are having some widening done with the osteotomy itself right? Is it Coceancig-style?

 

[brock]

Mm ok but you are having some widening done with the osteotomy itself right? Is it Coceancig-style?

Yes, 4mm each side coceanig-style.

 

[hansmoleman]

Yes, 4mm each side coceanig-style.

did the doctor say anything about the stability and safety of widening BSSO? Like, there are lots of cases and statistics about normal BSSO so we can have an idea about the risks, but jaw widening is rare. Did he say anything about that, has he done this with how many other patients?

 

[PlagiocephalyTypeIV]

What's shown in the design is infra + zygo. The paranasal will be done separately by hand.

Is the cost for infra only and infra + paranasal the same ?

 

[Oxygen]

That jaw implant looks awful from front profile. Any updates?

 

[Oxygen]

Also what are the prices of everything?

 

[Allornothing]

Your occlusal plane is fucked. Your maxilla is neither upswung or downswung it’s both. It’s like a slope that goes up and down. It’s downswung at your anterior nasal spine causing that fucked up nose shape and folds that undermine your forward growth.