nose shape post jaw surgery

[trossi]

I'm having double jaw surgery to correct an open bite and class III malocclusion. I noticed when my surgeon did imaging that my nose from the side profile appeared larger. Whenever I look at other peoples before and after images their noses look so much smaller after having the top jaw moved forward. I'll attached a picture to show my side profile. This is about a year ago before I got my braces, my bite is more open now. Can anyone help clarify if the digital imaging he did was just off? I'm not seeing my surgeon for a few months since I'm waiting for my extractions to heal. Thanks

[class3underbiteboy]

The nose would be more tipped upwards, and possibly wider. But not 'bigger' in appearance from all the cases I've seen. Usually it becomes more balanced and less flat.

[LAJaw]

I had a three-piece lefort I where my upper arch was expanded and moved forward very slightly (~1mm), and it did change my nose shape. My nose tilts up slightly more now and the bottom of my nose has widened a little bit. This combination makes my nostrils a lot more prominent now. Even though almost nobody noticed, it still bothered me for a while, but I'm getting used to it.

I think in general, an upper jaw advancement won't make your nose any bigger, but it will upturn your nose and widen it slightly at the bottom. The widening can be minimized using a special suture called an alar cinch, where a suture is put through the edges of your nostrils and then pulled together under your face.

[class3underbiteboy]

I had a three-piece lefort I where my upper arch was expanded and moved forward very slightly (~1mm), and it did change my nose shape. My nose tilts up slightly more now and the bottom of my nose has widened a little bit. This combination makes my nostrils a lot more prominent now. Even though almost nobody noticed, it still bothered me for a while, but I'm getting used to it.

I think in general, an upper jaw advancement won't make your nose any bigger, but it will upturn your nose and widen it slightly at the bottom. The widening can be minimized using a special suture called an alar cinch, where a suture is put through the edges of your nostrils and then pulled together under your face.

Did you choose not to have this alar cinch? I'm looking forward to having my nose turned up a bit (it's a bit flat imo), but don't really want it to become wider...

[suzanna]

Did you choose not to have this alar cinch? I'm looking forward to having my nose turned up a bit (it's a bit flat imo), but don't really want it to become wider...

I had this stitch done, my surgeon didn't ask me if I wanted it or not. I don't really think my nostrils are any wider but just a little more visible since the tip of my nose did turn up a bit. My surgeon said that if he didn't do the stitch, my nostrils would have been really wide and flat.

[trossi]

I had this stitch done, my surgeon didn't ask me if I wanted it or not. I don't really think my nostrils are any wider but just a little more visible since the tip of my nose did turn up a bit. My surgeon said that if he didn't do the stitch, my nostrils would have been really wide and flat.

If I remember correctly I think we have the same surgeon, Dr C at crescent? I'm going to be sure to bring it up with him, my nose is very narrow so I don't think the widening would be a horrible thing but I wouldn't mind it turning upwards since the profile is sort of convex so it makes my nose look like i have a dorsal hump. Hoping the surgery will make this less noticeable, that would be a great bonus.

[LAJaw]

Did you choose not to have this alar cinch? I'm looking forward to having my nose turned up a bit (it's a bit flat imo), but don't really want it to become wider...

I did get the alar cinch, but with upper jaw advancement & expansion, some widening is unavoidable. I was reading through Peterson's Principles (an oral surgery textbook) that had a chapter on soft tissue changes from jaw surgery. I can't remember the exact numbers off the top of my head, but it was something like a 3% widening of bottom of the nose with an alar cinch versus a 10+% widening without.

[class3underbiteboy]

Did you choose not to have this alar cinch? I'm looking forward to having my nose turned up a bit (it's a bit flat imo), but don't really want it to become wider...

I had this stitch done, my surgeon didn't ask me if I wanted it or not. I don't really think my nostrils are any wider but just a little more visible since the tip of my nose did turn up a bit. My surgeon said that if he didn't do the stitch, my nostrils would have been really wide and flat.

That's not such a bad effect imo, especially in my case. I do wonder at times if the nose looks the way it was supposed to after upper-jaw surgery.

Did you choose not to have this alar cinch? I'm looking forward to having my nose turned up a bit (it's a bit flat imo), but don't really want it to become wider...

I did get the alar cinch, but with upper jaw advancement & expansion, some widening is unavoidable. I was reading through Peterson's Principles (an oral surgery textbook) that had a chapter on soft tissue changes from jaw surgery. I can't remember the exact numbers off the top of my head, but it was something like a 3% widening of bottom of the nose with an alar cinch versus a 10+% widening without.

Lol only 3%? I would imagine it's a bit more on average since almost everybody who had this surgery done notices widening. Although swelling might have something to do with this observation.

[ceanna]

My surgeon told me that my nose would widen slightly and be a bit more upturned after the upper jaw advancement. But I had a fairly narrow nose to begin with so the effect wasn't too much. It did take some time to get used to the new look of my nose because previously my nostrils weren't visible when looking at my face straight-on and afterwards they were. If you don't like the effect of seeing too much nostril, don't worry, it does go down after several months as the swelling goes down.

One bonus is that the slight dorsal hump I had is less visible now.

[LAJaw]

I decided to look up the section from Peterson's Principles of Oral and Maxillofacial Surgery. From the chapter "Soft Tissue Changes Associated with Orthognathic Surgery":

They found that the alar bases widened in all patients and widening was lessened when
the alar cinch suture was used. The alar base widened an average of 2.9% with the alar cinch suture and 10.8% without it.41

41. Guymon M, Crosby D, Wolford LM. The alar base cinch suture to control nasal width in
maxillary osteotomies. Int J Adult Orthodon Orthognath Surg 1988;3:89–95.

If you want more detali, I would recommend browsing through Peterson's Principles. I was able to find a pdf version of it after a bit of googling. The "Soft Tissue Changes" chapter has a lot of interesting stuff, with diagrams about how various parts of the face move and case study pictures of patients with and without the alar cinch.

[thenumber12]

That was a great read LAjaw. Thanks for sharing.

[PhillipBryant]

Did you surgeon's bring up the alar cinch suture or did you bring it up after your research? I'm still in the very very beginnings of my journey (Just got my top braces yesterday)-- but I am going to have a segmental lefort (not sure if it will be 2 or 3 piece yet) and I am very curious as well about what is going to happen to my face in general-- but especially my nose.