When is lower jaw setback needed to correct underbite rather than just LF1?

6ft4

6ft4

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What determines whether the surgeon recommends just a lefort1 to make the jaws align or lefort1 + lower jaw setback?
I've looked at dozens of underbite surgery cases, some where lower jaw was set back and some where it wasn't and I can't see how advancing the upper jaw more wouldn't solve the problem in almost all setback cases
 
Depends upon if the surgeon is blackpilled or not.
 
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