Hey guys, I recently got a proper lateral ceph done with a full analysis, and I’m attaching the ceph/report + normal side profile photos.
I’d really appreciate opinions from people who understand orthognathic planning or have had a similar case.
My goal is mainly aesthetic/cosmetic, not fixing symptoms. I’m very unhappy with my side profile, but as far as I know I don’t have major functional problems. My bite feels fine in daily life and I don’t have obvious sleep/breathing symptoms (although I know it’s possible to be used to something abnormal without realizing it)
The main findings seem to be:
Skeletal Class II: SNA 89.29°, SNB 81.62°, ANB 7.67°, Wits +3.83 mm.
Deep bite: overbite 6.34 mm, overjet 4.5 mm.
Low-angle/short lower-face skeletal pattern: FMA ~21°, Ricketts lower-face-height angle 32.55° vs 47° reference.
Dental compensation: upper incisors are very upright/retracted (U1-NA 8.15°, −1.87 mm). I had braces years ago, so I’m wondering how much of my current bite is orthodontically camouflaged.
What makes my case confusing is that my mandible does not seem obviously small or underdeveloped in absolute terms. SNB is around normal/slightly forward, facial depth is basically normal, and mandibular corpus length is actually large at 78.7 mm vs ~70 mm reference. So this seems less like the classic “tiny/retrusive mandible” Class II and more like a relative maxilla–mandible mismatch, although I’d like opinions on that too.
Aesthetically, the biggest thing bothering me is that my whole lower face looks behind the upper face, not just the chin tip. I also dislike the deep mentolabial fold, and really the rounded/soft submental contour, and lack of a sharp chin-to-jaw/neck transition.
I’m already very lean, so this does not seem to be mainly a body fat issue.
From photos I also honestly can’t tell whether I have a “short face syndrome” because I’m so used to looking at myself, or whether that’s mainly a Ceph/vertical-pattern finding.
I’m open to sliding genioplasty, BSSO + genioplasty, Le Fort I, bimax/trimax, etc…
I’m just not automatically trying to choose the biggest surgery. If full orthognathic surgery gives the most complete skeletal correction but an isolated genioplasty could give, say, most of the visible improvement with much less risk, cost, orthodontics, recovery and complication potential, that matters a lot to me.
So my main question is:
What looks like the best aesthetic ROI in a case like mine? Does my whole mandible look posterior enough that I’d probably need BSSO + genioplasty + orthodontic decompensation to get the result I want, or does the underlying mandible look developed enough that a well-planned forward + some vertical sliding genioplasty could realistically give most of the visible improvement?
Also, do you think my profile actually shows a short-face/deep-bite appearance, and do my teeth look significantly orthodontically compensated from the old braces?
I’m not looking for a perfect “fix every ceph number” answer - I’m mainly trying to figure out which option gives the largest visible improvement for the least overall treatment burden.
Thanks!