lefort and gummy smile

[ggina]

No problem with the recovery, thank you.

As for "redraping" of the skin, I don't know how this might happen but I think when one's around 20, the skin is tight enough (because the bones are still in a growing phase somewhat) so if you cut out a few mm-s of bone the skin will be not as tight but at least it won't be loose. After 25, the bones stop growing and over 30, the skin starts to give itself over to gravity. It's not really visible until 40, well unless you remove some bone from underneath. This type of sagging skin is not always visible, however it becomes apparent if you look downwards with your face. Put a mirror in your lap and look down into it.

Yes, my smile is still gummy too but I already gave up on this. In my case this part wasn't a success. Studies say that soft tissues (skin) move with about 50% of the hard tissue (bone) movement so if you have a 8mm lefort impaction then the gummy smile can decrease only with 4mm. Other surgery parameters (how much of an advancement you'll have together with the impaction, etc.) can decrease this percentage even more.

So if one's not concerned about their facial height as I was, then the Lefort is just too serious a surgery just to remove the gummy smile. A simple VY-plasty (which usually all lefort patients get as well) can be enough to get rid of some gums, although it's only effective in the middle, not on the sides. In my case, decreased facial height is the only thing I got from the Lefort (to correct a syndrome called "vertical maxillary excess").

g

[keeponsmiling]

Hi gina - you say your surgery corrected vertical maxillary excess, which is one of my main reasons for treatment (that and an open bite). Can I ask how much the height of your face decreased? Going by what you were saying about soft tissue moving half the distance the bone is moved, does that mean the 3-5mm impaction planned for my upper jaw will only decrease face height by about 2mm? Or does whatever they do with the lower jaw and chin have more of an effect on face height? I don't want so much bone removed that I get all that saggy skin we've been discussing, but nor do I want major surgery that will only takes out a little bit of bone and therefore only gives a minor improvement. I did that mirror on the lap test btw - it's EVIL!!! Any other 0ver-thirties out there who ended up needing a facelift?

[bracedfaced]

Yes, I brought this up in a previous thread. Impactions tend to cause a drooping skin bulldog effect and doctors will not tell you this. I am over 30 and just had an impaction a month ago so I don't know whether I will end up with that problem. But I am not surprised at all. When I asked my surgeon about it, he quickly dismissed it, but let's face it, the extra skin has to go somewhere, right?

[ggina]

Actually I meant the "mirror in the lap" thing only for post-lefort checkup. Sorry that wasn't clear on my part. However, if it seems evil even before surgery, then you'll probably need a lift anyway

As for the decrease in facial height, the height will be of course less with exactly the amount of bone cut out. And I don't think there are surgeons out there who'd do less than, say 4mm impaction because as you say, there's no point doing such a dangerous surgery for such small rewards. The excess skin is of course there but it's not hanging down on your neck but it's gathered besides the base of the nose. So that's why there are those two bumps there.

Interestingly, this was the only one side effect my ortho told me about before the surgery but he also said that I'll look better because I have flat cheeks and these will fill them out somewhat. Well I believed him but found out later that he was wrong: the flat upper cheeks became all the more flat because the lower parts became fuller. So don't always believe what the doc tells you, try to question everything.

I don't know your exact situation but I think you should do it anyway and then decide on the facelift later on. Not everybody will need it, like, if you have full upper cheeks or tighter skin, then you might not. But even if you will, you won't need a full facelift like the old ladies do but just a small one. Compared to the lefort, its really nothing.

For starters, here are some really good info on lifts if you're interested:

http://www.realself.com/question/how-fa ... -face-lift


cheers,g

[SLiM2590]

I'm really worried about this now, especially because of how much they want to move my jaw. I'm not 30, but not far from it, although I think I have pretty tight skin.

[bracedfaced]

ggina, thank you for all the info. I think it would VERY helpful if you were willing to post a pre-surgery pic, a post-surgery but pre-lift pic, and a post-lift pic. I understand if you prefer not to, but I think it would help put things in perspective to those who have not yet had surgery and are concerned.

[Sams]

Hi all,

I'm 37. No one told me about the potential for face-sagging because of a jaw-reduction. I had noticed a change in my face shape with a squarer jawline and more rounded jowls. I concluded that the muscles need to re-adjust to the new shape and I think over time the sagging will ease (I've already noticed that the looser 'face' is firming up abit). I'm trying out facial exercies too which may help. I still have swelling around my nose so I can't really see my nose to lip indents yet.

Has anyone ever tried Eva Fraser's facial exercises?

[keeponsmiling]

I haven't heard of her but I'll definitely look into it! That said, I'm coming to the conclusion that everyone develops loose skin as they age and if surgery means that arrives prematurely, then surely that's still going to be better than spending the rest of my life with an open bite, slightly gummy smile, buck teeth (which braces have fixed but without surgery will probably move back out again), lip incompetence, the dimples in the skin of my chin created by trying to shut my mouth turning into full on wrinkles, not to mention all the self-esteem issues and the eternal 'what if' of never even trying to fix my jaw. It would be nice to come out of surgery 100% fab though!!

[Olive]

I'm scheduled for a Lefort (4 mm impaction) so naturally now I'm worried about this. Ggina, did you only have upper jaw surgery? I'm also going to have my lower moved out and possibly a genio, so I'm hoping that will sort of make up for any sagging that may result from the Lefort.. it may pick up the slack, at least around the lower cheek/jowl area.. does that make sense?

Also, I'm thinking, right now my lips can't close without straining... won't the Lefort, ideally, simply allow for my lips to close naturally without leaving excess skin? Right now, my mouth is usually hanging open about 4 mm and my teeth sort of stick out, I have to stretch my lips over the teeth. I would think that removing just enough bone so that my bite is closed and lips close at rest would not actually cause sagging.. it would sort of make it so the bone structure fits the tissue better, if anything.. but maybe that's just wishful thinking. I'm almost 27, by the way.

[ggina]

Olive, if you'll have a 4mm impaction, then your upper lip will come down approx. 2mm relative to the upper teeth line. So your lip strain when closing should get better and 2mm of teeth show is considered ideal. And you'll probably have a VY-closure as well which helps the upper lip to hang down a little bit and to not to lose its natural shape. This is a standard for all lefort procedures as far as I know.

I had genio as well. Which won't pick up the loose skin resulting from the lefort (it's too far away for that and the sutures pull that skin towards the nose anyway) but watch out, because you can get chin ptosis from genio, which means your mentalis muscle and lower lip can fall down somewhat, the amount probably depending on how much skin the chin picks up after it's been moved. I didn't have a mentalis strain before but now I do and it can't really be helped so be careful.

This means that when these two surgeries are done together, there's a chance that the distance between the natural position of the lips essentially won't change and you'll still live with the mentalis strain like you do now. Ask your surgeon what he can do to avoid this.

best of luck,g

[SLiM2590]

Sorry if this is a dumb question, but I put a mirror in my lap but I don't know what I'm looking for. Where is this skin supposed to be located, I don't see anything. My surgeon said that I have a 7-8 mm impaction. Sounds high .

[ggina]

you didn't yet have the surgery so there's not supposed to be any droopy skin right?

[SLiM2590]

Correct, but someone earlier mentioned how before surgery the mirror was scary or evil, so I'm just wondering where I'm supposed to be looking.

[keeponsmiling]

That was me - I put a mirror on my lap and then looked directly down into it and saw to my horror that even though I have no wrinkles and thought my skin was in good nick for someone approaching 33, gravity gave me about three chins!! It was like flashing forward thirty years LOL. I really don't think ANY surgeon would perform an op that would have such a dramatic side effect, but it's just an indicator that even if your skin looks good for 30+ it's still starting to loose elasticity and so a little sagginess about the jowls is probably inevitable.

Olive - we were on the same wavelength! I too hoped the lower jaw coming forward would take up some slack, but apparently not. If only things were that simple... Personally, I'm going ahead anyway - a cosmetically ageing side effect has got to be better than living out your life with a dodgy jaw.

[Olive]

Keeponsmiling, I do still believe that having a lower jaw advancement will provide some beneficial support for skin around the jawline (though that isn't what ggina was talking about specifically). Others have mentioned Lefort giving a "bulldog" look which I take to mean sagging jowls. And as it stands, my chin is so retruded that It looks like I have a double chin sometimes, even though I'm stick-thin!

Ggina, I haven't heard of that happening with genio... I'm not sure how I would "be careful," as it seems like it's a somewhat uncommon, unanticipated result. Anyway, I'm still deciding whether to get it, it would be purely cosmetic (there is a thread about it with my pics if you're curious). Did you have lower jaw advancement as well?