How to surgically correct an underbite - HAPSBURG jaw

How are you? Good, thanks. How are you? Good, good. Very well. Where are you right now? I'm at home. I'm going to share a screen with you, which is to define all your address details and so forth, if you don't mind. What is it that you fundamentally want to fix? The bike. So what is your complaint? Coming into this, what do you understand can be offered to correct it? That you can move either the upper or lower jaw or full. And what do you think I'm going to offer you? I'm going to offer upper and lower or upper only. What's your weight? 63. Any medical issues? Any psychiatric history? Any medications that you take? No, nothing. Any known drug allergies? And are you married or single? What do you do? IT, IT. Are you an IT student? I do my masters and do the same. Do you smoke? No. Do you drink? And you're single. Do you have anyone that looks after you? Oh, like in what way? If I operate on you, who would look after you? Yeah, my mom and my sister will come. And where will they come from? Pakistan? From UAE. Now, are you in braces at the moment? I already had braces. I have retainers now. And how long ago did you have braces? About 10 years ago. Have you had wisdom teeth removed? Have you had any dental extractions? I had something, but I don't know what it was. Do you breathe with your mouth open or closed? I don't know. When I sleep, my mouth opens. We're just going to come into another share screen. Here it is. So it looks like you've got a big lower jaw, obviously. You've got a very short or small airway just here. And so there's some advantage for us to actually try to make your jaw bigger a little bit. 9, 175, 2.5. Just bear with me. Can you see this screen here? Oh, yeah. Okay, so this is your face. So I'll just put your face on. So this is your face. And you can see the ears are level, the eyes are level, your eyebrows are level. And we're just going to put this structure right in the middle of your face like that. And you can see that this is a plane. And it goes right behind your skull and behind your upper jaw. And you can certainly see certain features of it that your right nostril is a bit smaller than your left. And whilst your lips in the middle and the base of your nose is in the middle, you've got more structure here than this side. The nasal tip is ever so slightly to the right. And you can see it's quite a steep jawline. Now when I saw you the other day, you had a full beard. You have a full beard now. But clearly there's no full beard here. What I'd like, if you don't mind, is if you can shave, you know, completely shave, and then I'll repeat the photos of you. Yeah, when it's necessary, then I'll do it. Okay, so you're slightly open here, but that's okay. I don't mind that. Okay. And I'm just going to look at you from the front. And you can certainly see that everything's level at your eyeballs there. Yeah. But your upper jaw is very up on one side. Does that make sense? And your lower jaw is also shifted to this side as well. Does that make sense? So what we're going to try to do is give you a bite. We have to operate on both jaws because, in effect, it's so off center. Can you see how the lower jaw is off to one side? Like higher? Yeah, it's higher on this side. It's lower on that side. So what I'm going to do is I'm just going to take away your lower jaw for a second. So we're just looking at your upper jaw, yeah? And I'm going to take away the calvarium for a little bit. And what I'm going to do is I'm going to straighten this up a little bit. You see this hangs down a bit and this hangs up. I'm just going to spin this out a little bit. You can see that this nostril here is a lot bigger than this nostril. And now it's fairly even, but now this tooth is hanging down. It's a bit like Dracula. What I need to do is just move it forward a little bit. And now it's fairly level. 28.5, 28.5. It's fairly symmetrical now. See, it's slightly asymmetrical there. Okay, so sorry about all that mucking around. You've got a fairly asymmetrical maxilla. So I'm trying to make it as symmetrical as possible for you. And opening up the top here to increase the nostril size on that side. Yep. All right. What I'm going to do is I'm just going to advance your upper jaw. Okay. To bring this point forward. That's very good. So now that's the new position of your upper jaw. Okay. Now you definitely need to have braces after this. But Maya, just bear with me for a second. So I'm widening it at the top. Mm-hmm. Does that make sense? Does that make my nose fat? No, it just means that you'll be able to breathe through it. Okay. So I'm opening up the airway at the top here so you can breathe through your nose on both sides. Yep. And we're going to lay in your lower jaw. Sorry, I'm just concentrating here a little bit. Yep. Just saving it so if it crashes, it's a tragedy. When you make these movements, the entire face is taken into account, right? Well, I looked at your face beforehand, but you've got a full beard. So it's very hard to see your face, obviously. Yep. So in effect, this is the bite that we would be able to give you. Yep. We're getting pretty close to pretty good teeth interdigitation where we don't have to remove wisdom teeth or anything like that. Okay. But you see that they don't mesh with each other. Yep. And you've got a very heavy contact on this tooth. Yep. This contact, because this tooth hangs down so much, we would be better off just to shave that tooth. Okay. So we've got a natural wear pattern to match that tooth. But fundamentally, it all looks like it's all very possible to do. Yep. So I'm substantially widening your upper jaw in the same procedure and I'm widening your lower jaw too. Yep. We're widening it across from here to here. To show you what I mean, I'm looking from below. Yep. It's still a bit thick on this side. Later on, I would want to add a little bit of extra bone here to fill that out so it's asymmetrical here. But I can't really do much more than what I've done there because I'm altering the bite there. If I try to swing it out more, this will swing out. Or if I swing it in, it will change the bite upstairs. Does that make sense? Sure. The one side is a bit thicker. You see how looking at it from below, right, it looks fuller on the left side compared to the right side. So whilst the angles of the jaw here, 50.3, about 50, they're equal. Yep. But here to there, 34.4, and here to here, it's two millimetres less thick. So the only thing we could do would be to add bone here to make it as thick as this. We don't want to take away bone. But I can't fold this in easily. I can't fold this in towards that line. I'm better off to leave it thicker. And I can't fold this out because it radically changes the level of your bite here. Even in this bite, your front teeth aren't meeting, but that's because your lower front teeth are leaning inwards and your upper front teeth are forward. So orthodontically, they'd be brought back and these would be brought forward. Does that make sense? From underneath, I'll show you what. So in effect, we're dramatically widening your jaw on that side and widening it here and bringing your chin forward a bit. We're reducing the height of your face quite a lot. So the height is being reduced that distance, almost 12 millimetres. Your upper jaw, we've been playing with a different position with your upper jaw, and your upper jaw is there at the moment. So I'm just... Oh, I won't hide it. But you can see just how far forward I'm moving your upper jaw. So you see how far forward I'm moving it. That's necessary, right? Yeah, yeah. Well, it's very necessary. But I'm sort of... I'm moving it down a bit too so you're seeing a bit more front teeth. Does that make sense? So will the side profile be changed, right? What's that? The side profile would look different then. Very different. You'd look very different. I can't explain how you're going to look different. So you're getting quite a square jaw. You're getting quite a square jaw. You can see how square it's becoming. And this cheekbone on your... You see how this cheekbone here is a lot further forward than that side? So later on, I would recommend that we graft this with a lot of cheekbone in there. Could I ask for a little bit of orthodontics before the surgery then? What's that? It's just that I want the orthodontist to push this tooth out a little bit. You see how it's really banging on that tooth? But it's not banging on that tooth. If he pushes that out, it just makes my job easier. A lot easier. Would you consider it? What do I have to do to convince you to consider it? Yeah, I want this tooth to be pushed out and these front teeth to be pushed forward. Does that make sense? Yeah, yeah. I'm just going to write some notes. Does that mean I would need braces on all my teeth? No, not braces, just Invisalign. You would definitely need Invisalign after surgery. Yeah, I need to fix it. I wanted to discuss the bite that you've created. You want to have another look at the skin? Yeah, yeah. You see that this tooth hangs down. It would have to be shaved and these teeth would have to be brought backwards. But you see I've created a little gap there so that these four teeth can be brought backwards. Yeah? As they're brought backwards, they will level up and these teeth will be leveled up as well with the Invisalign. After surgery. But if you wanted to improve the bite further, you would need to get veneers on, in particularly these two teeth, just to lengthen them a little bit. Right? Because this is literally the best I could do with surgery alone. I can't do any better than that. And afterwards, you see how this cheekbone is really small and this one's a little bit small. Later on, you see that gap? I've got to put bone in that gap so that it heals. Bone in that gap so it heals at the time of surgery. But I've really got to massively put a huge bone graft up here to give you cheekbones. What if I don't put cheekbones? Well, you just look a little bit odd. That's all. I just need it to look normal. Yeah. So if you want me to make you look normal, normal, I'd have to give you cheekbones. If you don't want cheekbones, it's up to you. And I can explain that surgery down the track. Okay? Yeah, yeah. So it's a pretty good... We call this a class 1 bite, but it's really interfering here, and it's a class 1 bite here, and I'm not pushing your jaw back. You see, I've advanced it just a little bit there and just a little bit there. If I push it back, I'll choke you. Does that make sense? And I don't think you want me to choke you. What about the widening? Well, the widening as well as advancing here opens up that airway so you don't choke. Does that make sense? Yeah, yeah. Will it look all natural looking? I don't want to look like I had some... I don't think anyone would notice that you've had any surgery. You'll just look like a normal guy. Like I'll still look like my family members and stuff? Yeah, you look like them. You just look normal. I don't want to look completely different. Well, I'm only widening your jaw here. I'm just bringing your upper jaw forward to sit over your front teeth. Okay, okay. I'm reducing your facial height a bit, but no one's going to notice, I don't think, to be honest. Yeah, that's fine. Did you have any other questions? So you're going to send me this, right? The videos and stuff. So that's the final plan? No, the final plan comes five or six weeks before your actual scheduled surgery. And that happens with the engineer. I'll bring you in on that if you'll be able to listen in to all of that. As long as I look normal in the end. You just look normal. Any other issues? No. Okay, I guess it's fine. Are there any other perceived risks from your perspective? I've sent you all the risks there. It's in that document. I've read that there's a chance of relapse and stuff. There's only a chance of orthodontic relapse. Surgery doesn't relapse. Are there really big movements? Well, your upper jaw is coming forward quite a bit. And it's been widened as well, right? A lot, yeah. So that's all included in the operation. Your smile looks nice. I would have a nice smile like that, right? Like that? These are veneers. So if you add veneers to your front teeth, it will lengthen the height a bit. The more teeth you veneer, the better it is. But you've got very natural teeth. My only advice is just to veneer the two front teeth, but that's after the Invisalign. And what about the bite? The bite gets settled by the Invisalign. That's the best I can do with the surgery. You saw all the little tweaks I'm doing. You know, just try it. Overall, after it's done, it'll look like that. There'll be harmony, right? There'll be what? Harmony? You will notice you don't have cheekbones. And you'll notice that one side's smaller than the other. You will notice that. But I look better than now. I'm just saying that you'll look normal. You'll look like you. Cheekbones won't be a huge issue, right? If I don't mind. It's a huge issue for most people. And I'll say that you have very, very small cheekbones. But at least I have a solution for it. It'll just be the same? I'm not changing your cheekbones. Okay. But afterwards, I can. Okay. But it's not necessary, right? If you want to look absolutely normal, yeah. If I get a regular BiMax, and they don't have cheekbones, and I get the Super BiMax, and you don't get the cheekbones, will that look better still? Say that again? Compared to another BiMax, a regular one. A regular one is literally random, what they do. But they use little plates, and they do tiny little movements. And it won't give you a bite anyway. To give you a bite is so ridiculously complicated, it requires the Super BiMax. With all that complexity that I just did, you saw how many pieces I have to put your mandible into. That's 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12. There are going to be 12 pieces of your lower jaw. And your upper jaw is significantly difficult to achieve that. But with the technology, we offer it to everybody because the technology makes it available. Thus far, I'm still the only one doing it, and that's it. Do you want me to show you what it looks like without cheekbones? Yeah, yeah. Alright, just wait. Are you in my phone? I have you on WhatsApp, yeah. On WhatsApp. Do you have an iPhone? I have an Android. Okay, alright, just bear with me. See if this comes through. He had a small lower jaw. Yeah, a very small lower jaw, yeah. Without the cheekbones, it looks like small over here. So his next step is to get cheekbone grafting. So he's only had the Bimax, and then he gets the cheekbones. Now, his upper jaw has come forward just as far as your upper jaw. So when you play that, his upper jaw is coming forward a long way, and it really highlights the lack of cheekbones. Is it not possible to reduce the movement a bit? If I do that, I have to push it all back, and when I push this backwards, I choke you. And then forever, for the rest of your life, you're snoring. So I'll show you another. So this is before, and this is after. And I'll show you what it looks like after cheekbones. I'm just trying to find a picture with her after cheekbones. Find a photo. Yeah, I can't find a photo of her after. Ah, here's one. This is after cheekbones. You need the cheekbones. What's that? You need the cheekbones with the thing. Yeah, it just still looks natural. I'll show you another one where she sent me, because she lives overseas, so I haven't been able to take photos of her. So this is after cheekbones. When you compare it to where she started, you know, she had a big Bimax, and then we graphed cheekbones to match. It just makes it all look natural, that's all. I'll show you another lady. I just don't have a before of her, but she had a big Bimax as well. So this is after cheekbones. Does that make sense? Yeah. Any other questions? No, that's good. Yeah. All right, I'll let you go. All right, yeah. All right. Lovely seeing you, and I'll put that to YouTube. Okay, all right. All right, thank you. Cheers, bye. Yeah.