BSSO + Le Fort I + Sliding Genioplasty

[Picollo30]

Hi guys

First of all let me introduce myself. Name's Paulo, i'm 39 and i'm from Portugal.

The reason that brought me here is to understand more about the surgery that i think it will be done on me according to the words of the surgeon, BSSO + Le Fort 1

I started an orthodontics treatment in 2010 to treat a Class II retrognathia. Before starting the treatment in this clinic i visited some maxilo facial surgeons and they told me i had to go through orthognatic surgery, but the waiting time was 10 years and if i didnt want to wait, the price would be about €15.000, a value that i couldn't afford.

So i was told of this clinic where they masked my problem, they focused on the teeth and ignored the mandibular and maxilar problems. I have clicks in my jaws, i have trouble to eat some food, apples for example, sometimes the mandibles jump and need to be put on their position, smile is still gummy but not as it was before. I also have lots of headaches that i think might be related to the jaw problem.

Aesthetically i still have a receeded/weak jaw and chin despite the treatment and one side of the face is well more developed than the other (facial assymetry), also i have malar hypoplasia (flat cheeks) all of this due to very mild treacher collins symptoms (some of the issues already have been fixed with otoplasty rhino/septoplasty and negative cantal tilt eyelid surgery). Needless to say, my romantic life and self esteem were also affected by this. Also being a mouth breather all my life didnt help my facial features as well.

What they did was: they used a palatal expander they removed a pre molar and aligned the teeth. I dont like the final result so i contacted a surgeon. I told him that it's 5 years since im using braces, he said it was a lot, and i told him what they did and he told me that despite the treatment being almost concluded that i could revert it somewhat,and he told me about the bilateral sagital split osteotomy and the lefort 1 (for the gummy smile) with genioplasty / malar/cheek implants or not (it depends on the outcome of the surgery).

He was also worried about the loss of fat in my face and the airflow issue that he thinks could be causing or can lead to sleep apnea in the future.

Judging by the cephalogram airways are 4 mm and doctor said the normal should be 1 cm.

here it is http://i1188.photobucket.com/albums/z416/Picollo30/PAULOMONTEIROCEFALO.png. What do you guys make of my ceph?

and here's a pic where you can see the concave profile and weak chin/jaw (despite being masked by the beard, without the beard its even more noticeable).
http://i1188.photobucket.com/albums/z416/Picollo30/dsdsdd.png

I have some questions.

1) Will my face change much with this surgery? Is it worth it age 40?

2) Do i need to use braces during and after the surgery and also i have 3 wisdom teeth, should i remove them before the surgery?

3) Does recovery take an extensive amount of time?

4) Will a Le Fort 1 procedure solve my flat cheeks problem (3 fat transfers to the malar were done by a PS, but fat was absorbed by the body everytime) and also will the genioplasty fix the weak chin?

thanks in advance

[PloskoPlus]

Some surgeons like to remove wisdom teeth before the main surgery. Some do it during the main surgery. The latter maybe the more modern approach.

[molestrip]

Wow, 4mm. I've seen lower but not much. You should be on CPAP if you're not already. Yes, you need surgery.

1) Yes you're face will change and in your case, a lot. Some of it will be good, you'll have a flat profile. You need like 6-8mm added to your airway, which is going to be tough without changes to the nose. Is it worth it at 40? You're still young enough for surgery and have plenty of time to not die in the next decade.

2) Whether you need braces is up to the surgeon. If your occlusion is good, then you might not. In Europe, I don't know of anyone who does that but surgery first is more prevalent there so maybe just afterwards. Wisdom teeth likely removed during jaw surgery by a good guy.

3) Yes, recovery takes a long time. First few weeks are the hardest. It's about 3-4mo until you can fully eat normally again and a year until your bones are normal radiographically. Swelling and nerve sensation loss can take up to a year to return to normal. People are generally happy with the results nonetheless.

4) Jaw surgery may be enough to fix your weak chin. You may need sliding genioplasty as well, up to the surgeon. We all have flat cheeks and recessed orbital rims too. Your options are better in Europe. There's people there who can do a high LeFort 1 or an osteotomy. Here it's more common to get implants. Whether it's worth it is unclear, people aren't generally as happy with that work as they are with jaw surgery.

Since you're in Portugal, I'd highly recommend a consult with Dr Alfaro in Spain. There's also a doctor who used to frequent here, Dr Birbe. Get a sleep study before your consultations. Surgeon fees from top guys is about $40k USD and worth every penny. You don't want to compromise here, most surgeons would screw a case like yours up.