It's a pear shaped HOLE. So hard to pin point where. Basically, you can't cut out a cross section of bone; a horizontal cross section of bone when a FEATURE (like the NOSE) is there.

Man, this is confusing. It's making me wish I had gone to medical school.

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Thanks for that. I see what you're getting at. Maybe this is a stupid question, but would it be possible to say cut around sides of the periform aperture, essentially isolating it so it wasn't 'violated', and then making cuts in the maxilla lateral to the periform?

No, the PA is a HOLE that separates both sides of the maxilla (maxilla is 2 bones)

I guess I was referring something like this:



This corresponds to a LeFort II. The whole upper maxilla, along with the nose, is brought forward. The piriform aperture isn't violated because the cuts are made around it. I haven't heard much about this procedure. Would a surgeon be willing to do it on a normal person like me who just has an extremely retrusive upper maxilla (in the words of the Merrimack guy I saw)? Also, when you said that you can't take cross sections of bone do you mean that bone can only be cut along fracture lines? I notice all these procedures follow fracture lines in the bone.

Since developing an interest in orthognathic surgery, I've become more attuned to skeletal/dental 'deformities' in other faces. For fun here are some models with different jaw/bite problems and my best guesss:

Inguna Butane -- Slight overbite




Notice the depth of the sulcus below her lower lip. She gets away with it, though, since her chin isn't very recessive, and that kind of masks the problem. I've actually noticed a lot of models have overbites coupled with short maxillas. They tend to have deformities more in the neotenous direction. It's been well established that neotenous features are deemed more attractive, so that makes sense. The baby/doll look is currently in vogue in the fashion world. You had more horsey-faced models in the eighties and early nineties with Cindy Crawford and Christy Turlington. Not that these girls were Class III, but they had longer faces.
Class III types are rare on models, and usually the models who have them are meant solely for shock value (see below).

Anna-Maria Urazhevskaya -- very underdeveloped maxilla and mandible



Gives her that exaggerated neotenous look with the huge eyes and dainty lower face.

Now onto some of the scary ones

Adina Fohlin -- prognathic maxilla and mandible:


Gives her a Neanderthalesque look. It doesn't help that she has a very strong browbone.

Doutzen Kroes -- This model has a milder form of the upper/lower jaw prognathism, but it works in her case. She's very pretty:


Her jaws project from her forehead kind of like a shelf. Because she has very full lips and innocent-looking, doe eyes, tihs gives her a sexy pouty cast.


Daiane Conteiro -- Falls into the shock category. Class III



Note how her lower lip protrudes and a straight line (instead of a concave one) connects the vermillion border to the sulcus of her chin. (this is the thing I was talking about that Frances McDormand also has. Actually in Frances' case, the line is almost convex ). You can tell her teeth are pushing the flesh there forward.
In textbook Class III fashion, Daiane's nose is droopy and recessive and her midface is very flat. She'd really benefit from some ortho work.

Few general observations:

Slavic women tend to have more neotenous variations, while Germanic and Scandinavian women have more prognathism (both upper and lower jaw). I'm not so sure about other ethnicities, but I have noticed that a lot of Asian women have overbites and narrow arches, while African women tend to have bimaxillary protrusion and lower jaw prognathism. It would be interesting to see if anthropological studies confirm my observations

In some cases the deformity works and almost enhances the distinctive beauty of a person's face, while in other cases it really detracts. I guess it all has to do with the severity of the variation and how it interacts with the other features.

OK, that's the Lefort 3(which I said was Lefort 3 earlier). That one is not going through periform aperature or vertically shortening maxilla via a horizontal cross section. The lefort 1, the ones the max fax usually does is cut somewhere near the aveolear process but I don't think there are suture lines there. In the other ones, they move with the suture lines.

It was either LeFort or Tessier, forget who, who smashed many skulls against the wall to see where they fractured. So where a scull fractures can differ somewhat to where the suture lines are. Usually they fracture close to the suture lines but in the case of the maxilla near the teeth, the fracture is sort of below the periform aperture and somewhere on alveolar process.

I think you would be hard pressed to find a doc who would give you a LeFort 3 just for cosmetic tweaking.

carlenr wrote:I guess I was referring something like this:



This corresponds to a LeFort II. The whole upper maxilla, along with the nose, is brought forward. The piriform aperture isn't violated because the cuts are made around it. I haven't heard much about this procedure. Would a surgeon be willing to do it on a normal person like me who just has an extremely retrusive upper maxilla (in the words of the Merrimack guy I saw)? Also, when you said that you can't take cross sections of bone do you mean that bone can only be cut along fracture lines? I notice all these procedures follow fracture lines in the bone.

they probably all have their teeth aligned through braces as to not have over or underbites but maybe started with the jaw relationships that lead to the bite.

Anthropometrical norms differ from ethnic group to ethic group. So there are a lot of variations. Some groups lean more toward bi-max protrusion (Asian, Afro) and some don't (Mediterranean) . There are established norms for each group. I would not call any of the looks of those models in category of a "deformity" though.

What about a Lefort II shown as B here:


Do you think a surgeon would be willing to do that for cosmetic reasons?

Btw, didn't mean to imply those models were 'deformed.' Lol. I couldn't think of the proper term to describe mild skeletal variations from the norm.

What confuses me about the Lefort I is skull diagrams don't depict much of a gap between the top of the teeth and the nasal spine. That doesn't leave much room for the surgeon to shorten the maxilla. Perhaps that length varies a lot between individuals and most diagrams just illustrate the 'norm.'

Is it possible to determine where the extra maxilla length is in a face just by looking at it? I have a lot of space between my nose and upper lip yet normal tooth show, so it seems like the length should be in that part of the maxilla. Yet when I feel around in my gums the top of my teeth almost hit up against the bottom of my nose. Is it possible the roots of my teeth are just really long, and if so can anything be done to shorten them? Since you mentioned that you have excess maxilla between your incisors, I'm wondering where the roots of your teeth end when you feel around inside your gums.

I'm looking forward to getting some cephs so I can stop with all this guesswork!

Well, the pyramid shaped one is the Lefort 2 alright. But like the LeFort 3, I don't know if its something they do for cosmetics. Even if they did, it would require moving out the mandible with it for the bite.

I use a simple algorithm for the basic core harmony which is my 1:1 ratio: I take a horizontal line passing through midpupil. From there, I look for a measure that is mid pupil to mid pupil or iris ledge to iris ledge but not beyond the iris ledge. If I can find a vertical line from mid point of that horizontal line where vertical is midpoint of line to somewhere near the lip 'part' and they are equal, then person has "1:1" ratio. Basically, I see if I can find a 1:1 ratio and rule of thumb is to look for a horizontal distance that equals a vertical distance but to stay within constraints of mid pupil to mid pupil or iris ledge to iris ledge. If I get a long vertical distance, to see where on maxilla that is coming from, I use Leonardo's rule of 1/3rds. If the lower 1/3rd is longer than middle 1/3d, excess comes from between nose and mouth. Also if from the bottom 1/3rd (just that part) the distance from nose to lip part is MORE than 1/3rd of total distance from nose to base of chin. If the excess is not coming from there, the excess is spanning where the nose/periform aperture is. That was Carter's case. His excess of maxilla came from a place they CAN'T change and nose followed the span of that section of the maxilla length.

I might be the only person who uses that measure system as I kind of 'cracked it' by doing a lot of observations on relative measures associated with beauty. So, it's cumbersome to explain. I use it to analyze the face when I'm morphing someone and to analyze the morphs for what kind of displacements I made. Basically to keep me in check from making changes that I know are not going to in anyway correspond to surgeries done.

I think the fossas; like the canine fossa are larger than the roots. Like the roots are somewhere in them but don't extend the height of the actual fossa. I know a protrusive canine fossa can have too much curvature to it and the curvature gets in way of placing a paranasal implant. I've seen skull models on Dr. Y's desk with really protrusive canine fossas like way up beside periform.

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Yes, my maxilla does 'break' your 1-1 relationship. I just checked. Not grossly, but by a few mms. The distance from my nose to chin point is also greater than the upper two parts of my face. The only thing is I also have an overly long chin, so I don't know if that might be accounting for the extra length of the lower face.

So does your smile sort of dip down in the middle like Jennifer Aniston's?

Just reread your entry and realized I missed a part. Yes, in the bottom 1/3 of my face the distance from the base of my nose to my lip part is definitely more than 1/3 of the total nose to chin distance. In fact, it almost spans half the distance. And I have a long chin so that can't be good!