lefort and gummy smile

[ggina]

Hi,

Just a short question: if one has a 5mm Lefort impaction and 1.5mm advancement, and an initial gummy smile of 3-5mm, then how much gum show could be expected after surgery and what are the usual time frame for changes to occur?

I was in a rather naive belief that the bone and soft tissue movement ratio is 1:1, didn't even ask the surgeon about it. So if I have 5mm gum show and a 5mm impaction, then 0mm gum show should be the result. Apparently, it isn't because I still show 2-3mm. I'm at three months post-op and was told to wait at least a year but I just don't think that significant change could occur.

In a google book called "Oral and Maxillofacial Surgery: Orthognathic surgery" by Raymond J. Fonseca, I've found that the upper lip usually moves with about 50% of the hard tissue (bone) movement (page 486), altough he doesn't mention time frames. So this is basically the result I've had but still confuses me to no end, because I've seen here and at other sites some really convincing before-after photos where the gum show was completely eliminated. I think an advancement of 1.5mm is just not big enough to mess up the results of the impaction so much. Or is it?

What are your experiences?

Thanks,g

[sarz]

My LFO's were all based on opal predictive software (ops) planning. Presumably my old ortho used dentofacial planner too. The ops software is based on generalisations which I only discovered after the third go. There is some fascinating research online on the computerised planning of orthognathic surgery - Journals provide the most evidence based research. This was a good foundation for the beginning of my research when things did not go to plan. I now show more gum than LFO surgery two - which wasn't expected.
What type of planning is your ortho using?

[sarz]

sorry, just read your post underneath - you have had your surgery already.
It sounds like you were given some good information before your surgery which is helpful.
My best wishes to you in the recovery process.

[ggina]

No I hadn't been given any information before surgery, that's what the problem is Now that I'm through, I'm just trying to figure out what happened... Anyway, thank you for your wishes regarding the recovery, I need that

g

[sarahorsomeone]

I imagine everyone's soft tissues change differently. I had 6-8mm of gingival show when smiling and an impaction of 6mm with a slight advancement as you did; I now don't really have a gummy smile at all. I do show a little gum, but that's from where I had gaps between my teeth pre-orthodontics and the gum has sort of got "stuck" between the teeth (I'll need a periodontist or cosmetic dentist to sort that out at some point).

A bit of gum show is generally considered quite normal, especially in women, my surgeon would have left me with a mm or two of gum show if it wasn't for my lip-incompetence. Getting my lips to meet properly was quite high up the list of priorities because it was affecting my speech.

[ggina]

Did your gummy smile disappear right after the surgery or you had to wait a few months?

[sarahorsomeone]

Did your gummy smile disappear right after the surgery or you had to wait a few months?

It disappeared straight away, although my smile was a little odd for the first few weeks because of stiffness and swelling, plus my upper lip sort of kept turning inwards for a while (as I described on my other post).

[ggina]

oh, lucky you... Then this probably means that I cannot really expect any significant changes from now on. I guess I should've went to a better surgeon. I don't want to have another surgery, the recovery is so difficult with this. You know, I'd gladly wore these metal plates inside my face if the result was worth it, but in this case I feel they're totally useless. I don't know what I'm going to do now, except hope for a miracle. I feel so messed up now.

g

[sarahorsomeone]

You know, the 2-3mm of gingival show that you describe is by no means abnormal, especially in women. Even so, with such a small amount of gum showing, you might be able to get it corrected by gum contouring (the procedure I need to tidy up the bits where the gum has got stuck between the teeth).

You keep coming up with more things you don't like about your new face and I worry that no matter what you have done you'll still find something else you don't like.. Nobody looks perfect but it's something people have to come to terms with. It doesn't sound like you were happy about your appearance pre-surgery either.

[ggina]

Yes you're absolutely right in everything you've said Except that periodontics are not an option because my teeth aren't small. I don't want to swap my gummy smile for horse teeth, that would be another meaningless action on my part

I'm just saying that there's just no point in going through such a dangerous surgery for such a small change, especially if the desired results are not achievable. I'd advise anyone who contemplates something similar to think twice. Of course if someone has serious functional or aesthetic problems (like most people on this site) then there's no alternative. Mine was only the gummy smile and it didn't worth it at all, because I seem to have traded in a part of one negative aspect for a whole lot of others. As I've already said, if I could've at least get rid of those gums I wouldn't care about the other side effects.

However, I won't give up and will keep looking for opinions and possible solutions. If I find something worthy of posting, I'll post it.

g

[ggina]

hello, I thought I'd drop in for just a small update:

I've recently had a mini facelift performed on me to tighten the sagging skin beside my nose (lower cheeks) that was the remnants of the lefort impaction. My other problems are of course not solved but at least I got rid of the bulldog/chipmunk/chubby cheeks that this type of surgery usually introduces.

I don't know how is this with younger people because their skin is more elastic and might become tight even after lefort but for older patients I think surgeons should mention that a facelift will be necessary to avoid this kind of strange look. I wonder why this is not mentioned here in these forums more often, because this surgery is cheap, the recovery time is only a few days and it's absolutely worth it.

I was more or less patient with this, but there's no reason to wait more than six months for these bumps to disappear by themselves because they won't. Excess skin is just excess skin, it has nowhere to go, it has to be helped somehow.

cheers,g

[Sams]

How old are you ggina if i may ask?

[ggina]

im just over thirty.

[SLiM2590]

This is a little disheartening but one of my concerns. I was just reading the blog of a girl who had Lefort to get rid of her gummy smile and to me, her smile is still gummy, but she likes the resuts. I didn't notice a puffy face, if anything her face was more defined after and less chubby. I'll add this to the list of questions to ask my surgeon.

[keeponsmiling]

Yikes! I read a thread a few weeks ago about the potential for skin to sag after Lefort 1 and kind of hoped I would still be young enough to get away with it - I'll be 33 when I have surgery. I know that in younger patients the skin 'redrapes' itself over the new bone structure but I totally agree ggina that no surgeons seem to mention the potential need for a facelift. I guess the age at which the skin can't redrape varies a lot from person to person, but it would have been nice if someone professional had mentioned it before I committed to braces. Hope you made a quick recovery gina.