jawsurgeryforums.com
Before/After Photos => Other => Topic started by: Snackan1986 on June 04, 2013, 11:39:03 AM
-
Hi everybody
Had double jaw surgery September 2012 to correct open bite, overbite and also correct a little of asymmetry. I don?t know my exact measures from surgery but the lower jaw was advanced about 10 mm and then the upper jaw was impacted downward (I think that?s the term). No genioplasty yet however I guess I will have to do that as well. Just that I am not really pleased about the aesthetics netither the bite, since I only bite together with 2 teeth on my left side, and 4 on the right. Also I have begun to wonder if I did not have needed a counter clockwise rotation instead. That way the chin should also have come forward more I guess. What do you say about the pictures below, is a genio enough to do to get a quite good profile and hopefully "cure" lip incompetence and mentalis strain and also what do you say about my theory on counter clockwise rotation? (The front pics are 2-3 months post surgery and side profile is a new pic, 9 months post op). Don?t have any before pics at the moment though
[attachment deleted by admin]
-
I will try to update the pics with better and bigger quality ASAP
-
pics are terrible and it's tough to say!
-
Hi again,
I have tried to take better pics (obviously I?m the worst photographer ever and my phone?s camera is not good enough). Anyway please see the two new attachement?s which at least is a little bit better, even tried to mark out the jaw line in one of them with small dots.
[attachment deleted by admin]
-
Yes I believe ccw should be done
-
One major reason why I strongly oppose Obamacare.
-
Hmm, I'm curious to see the before photos. I do agree that ccw may have given a better result, I think it's a case by case basis, but with your facial structure it would make sense. It doesn't sound like your bite is aligning well either.
-
I appreciate your comments...
I have looked for before photos but can?t find any that show the jaw or face in a good view. I think I will make a claim to the hospital that I want to have a copy of my journal, so hopefully the before pics are included there, however it will take a while before I will get it though, but when I do I will of course upload them. I will keep looking through my computer as well.
Seems like most of you are saying a CCW should have given a better result at least aestethically. I hope the surgeon have a good explanation why they did not do a CCW. I have requested a meeting with the surgeon however not until mid August. Anyway I wonder what makes CCW more risky, since I read on Arnett/Gunson homepage that a lot of surgeons won?t due CCW due to ?poor stability?, which Arnett/Gunson don?t agree with I think. Is CCW also to prefer to improve the bite not just aesthetically in cases where the mandible is too vertical? I am not so excited to do a really big genioplasty (with unnatural look) just to hide a poor result from double jaw surgery if it could have been much better with CCW but of course not so keen on going through double jaw surgery again. I have tried to find some x-rays on Google which shows CCW before and after but I have not found any good ones.
Alue: My bite is far from perfect, but it?s of course much better than before surgery. I hoped it would be better, but now I feel that maybe my expectations was too high, but looking on pictures from other people who had open bite their bite look much better than mine. So far I also have some other benefits from the surgery including that my jaw can relax a little bit more and I have not had much jaw pain as before surgery, to set things into perspective.
-
Your case exemplifies two things:
1. The importance of the genioplasty for patients with extremely high mandibular plane angles (MPA).
In these cases, genioplasties have an effect entirely out of proportion to their cost. Using an upward and forward movement, they can be used to correct a surprising amount of anterosuperior deficiency. Depending on your current mandibular contour, you can gain up to 8mm of chin projection with a standard sliding genioplasty; this effect will be magnified further by the superiorly directed movement.
2. The aesthetic limitations of linear movement for said patients.
Obviously, a 10mm advancement is a fairly large for any surgical advancement. However, in extremely high MPA cases, a large part (if not the majority) of the advancement actually translates to vertical--rather than horizontal--movement. In the absence of a genioplasty or significant impaction, the face is actually lengthened, and the chin only marginally advanced, both of which contribute to an unsatisfactory result.
-
Hi all,
Finally received my x-rays. Before braces, braces, one day after surgery (lots of swelling so does not look good and 9 months post surgery + before and after "sketch". Press on Img001.pdf below to see the before and after "sketch".
A correction of the last posts I made. I said the lower jaw was advanced 10 mm, however it was not true, much less however the surgeon gave me no number, but just said it was not much advanced, but it was advanced more on the right side than left side.
My bite right now. I can bite together with one tooth on my left side and like 3-4 on the right side. Can barely chew on left side.
Also my lip incompetence is quite bad and a lot of strain and muscle tension to make my lip meet and I have difficulties to really relaxe my facial muscles and my lips "wants to close" however since it takes so much effort my whole face get tensed. So I always try to relaxe as much as possible in lips and chin but it?s difficult.
Face: Almost seem like the braces did more to the profile than the surgery did :)
My options:
#Redo surgery so my bite on left side will improve,
#Genioplasty of 8-10 mm I think they said which would give me like 6-7 mm. How much could a genioplasty improve lip incompetence (muscle tensions)?
#Shave on the back teeth on my left side (I don?t think this will improve the result but could actually make it worse since it would only improve the bite so slightly so I refused this option when I visited them last week)
#Do nothing
Any comments?
[attachment deleted by admin]
[attachment deleted by admin]
-
Snackan1986: Don't you live in Sweden?
-
Snackan1986: Don't you live in Sweden?
Yes, I live in Sweden...quite far from US I know:)
-
Hi Snackan1986. I'm sorry to have to tell you this but from the looks of the images you posted before, and these X-rays, your surgeon is not very skilled at all. To me you still look like someone who needs jaw surgery, not someone who has had jaw surgery. Your surgeon doesn't seem to have addressed your issues with having a steep jaw angle and severe recession. I can't believe he admitted to not giving you much advancement, that's just shabby. Why did he think you were getting surgery?
Aesthetics wise, and bitewise you still need another surgery. A genioplasty won't do for you either because of your steep occlusal plane. It would look strange. Are there any other surgeons in Sweden that you trust and who can see you?
-
Hey,
I do believe you need another jaw surgery. I feel like there is so much that could be done in a second surgery to help you aesthetically and functionally. You need a genioplasty also, but I would not consider one by itself without fixing your jaw and bite issues first.
If I were you I would be firm in asking the surgeon exactly what moves were made to your jaws the first time. How many mm's did your lower jaw move forward, upper jaw move forward, how much impaction did you have, did you have any rotation?
It doesn't fly well with me that your surgeon told you he was going to move your lower mandible 10mm but then he didn't, and you don't even know how much he ended up moving it? You have a right to know exactly what was done in the OR. It is just plain sloppy if the surgeon can't even tell you EXACTLY how many mm's you were advanced. These things should be planned out 100% using cephalometric tracings before the surgery, and the plan should not change during surgery.
I sadly agree that your surgeon appears to be incompetent. Please find the best surgeons you can and get their opinion. Aesthetically and functionally you can still get your issues fixed in the hands of a great surgeon.
-
Hey,
listen dude, for you I think you NEED arnett to do your surgery, but ask for a genio as well. Reason I'm even advocating this is I recall on one of the forums, maybe it was jawsurgeryblogs or some other that there was a girl from sweden who got her surgery done with arnett/gunson and the swedish govt. paid for it since you guys have such good socialized healthcare.
DUDE, inquire, plead, force your govt to pay for your surgery. Your results are (don't feel bad, it can be fixed) the worse I've seen ever. But again, it can all be fixed, you're a handsome guy, great bone structure, you're really young, you'll look like a model once you get this s**t corrected and more imp. you might be able to have it all done for free. Now I'm not exactly sure whether the chick was from Norway or Sweden --but whatever potatoe potahtoe, contact your embassy, head of whatever govt. healthcare agency, make a MASSIVE case that your surgeon f**ked up and the only people you'll trust are in California --I think it will work and you'll end up with great results!
-
I agree that he needs a genio but only as part of another jaw surgery. A genio done on its own would look strange with his jaws being the way they are.
Snackan, have you wondered whether the surgeon made your jaws worse after surgery. If he can't tell you how far they were advanced, how do you he didn't make you more recessed?
Lazlo, I can't see Sweden or any other country paying 100K for an Arnett surgery. That really is a pipe dream. Especially with the economic situation the way it is now. Governments use social healthcare to reduce costs, not increase them by buying expensive private surgeries.
-
I agree that he needs a genio but only as part of another jaw surgery. A genio done on its own would look strange with his jaws being the way they are.
Snackan, have you wondered whether the surgeon made your jaws worse after surgery. If he can't tell you how far they were advanced, how do you he didn't make you more recessed?
Lazlo, I can't see Sweden or any other country paying 100K for an Arnett surgery. That really is a pipe dream. Especially with the economic situation the way it is now. Governments use social healthcare to reduce costs, not increase them by buying expensive private surgeries.
no dude, this is the absolute truth, there was a girl on one of the forums, i thinking more and more she was from norway, others will vouch for this her post might stills be up on jawsurgeryblogs and because there was no one good enough in norway or because of the nature of her surgery or something like that (it was jaw surgery) her govt. paid for her surgery with arnett/gunson (it was either the govt/ or her insurance in norway I can't remember which) --but do remember that she had to do certain things through her consulate to have it done.
-
Thanks for everybody?s comments.
I will try to reply to all of them quickly in one post, but won?t refer to any quotes.
I understand from all of your comments I really should benefit a lot from a second surgery with a better surgeon, so I will be looking for surgeons for consult to see what to do. Also I will see if I could meet with my surgeon again and try to understand why he has not been able to give me better results both the bite and aestethic. I have emailed a couple of surgeons in US now and also been advised about a couple of surgeons in other countries which I might also consider contacting. Of course it would be much easier if I could have it done in Sweden however I don?t see how it would be possible to find which one is better than the other since all of the surgeons are working publicly and not private, so no information on the internet etc. Also I wonder if Swedish surgeons perhaps do these kind of surgeries to seldom, hence explains the result and my bite may have been a difficult case for them which they are not used to (?). So I don?t think I could trust a Swedish surgeon one more time.
I don?t think I had no rotation of the maxilla at all, as seen in my post with x-rays in the PDF file. However due to the impaction of the maxilla there were some autorotation of the mandible.
I don?t think Swedish government will pay for a surgery with Gunson/Arnett however it?s possible that a Norwegian girl did that. Norway is a very rich country :) However if my surgery results are as bad as everybody says they should pay some, but I don?t think they will.
Overbiter: Yes I am sure the mandible was actually advanced, but there must have been a misunderstanding between me and the surgeon about the 10 mm. I will try to get my full journal from them, so perhaps it could also explain any questionmarks.
Everybody write about how the incompetent the surgeons must be. Could there be any reasonable explanation the surgeon did what he did? And also why CCW was not done - for exampel extra risk in any way?
Before surgery I was perhaps also to focused on just the functionality of the bite and did trust the surgeons about the face aestethics. Also in Sweden you can?t really choose surgeon so everybody know. You can only have the surgeons in the country council you live in, otherwise the country council have to pay for the surgery if it?s done in other country councils which they normally not accept. I did not have to pay for neither surgery or braces.
/Niklas
-
Is this me you're all talking about ? :)
I'm norwegian. I'm not sure if I posted anything here, but I posted something in another forum. My case was not severe. I had a consultation with Gunson, but ended up doing it with dr. Relle for different reasons. And YES Norway paid for it, but the only reason for that was that I was studying in LA at the moment. If you're a student abroad norway will cover all your health costs while you're studying. So -you might want to do it like I did -now I have both an MFA and I had a surgery hi hi ;)
-
PS. Dr. Relle talked about norwegian surgeons being so up-to-date on orthognatic surgery. I don't understand that at all. They wouldn't do surgery on me! They wont do surgery on you unless you look like a freak. They don't care at all about aesthetics, and at least not lip incompetence. They did a genio to hide my bite. Not until I got to California I started researching and finally found dr. Relle.
that being said -I'm a bit nervous now. I had my surgery 5 months ago, and I still have problems closing my mouth, so I'm freaking out a bit. 5 months is a lot, I thought everything should be great now. I'm worried that he didn't move my upper jaw enough.
-
yes, still have to force my lips together. And it's better of course, but it's still not quite there.. It seems like the more severe your bite are, the better jaw surgery can help you. Pretty obvious, but then you would think they could help me with no problem, when the pre-op situation isn't that bad. I don't want to post any photos on the forum I think. Of course I talked to dr Relle about it -he keeps telling me to be patient. I will go to him in October and bring it up once more. But -what would a surgeon do in this case -if he sees that he surely should have moved my upper jaw slightly more -would he do a second surgery -and would I have to pay for that? I don't have money to do that, and I will never get it covered twice by Norway. I am satisfied, and think I could live with this, and it might even be better after a full year. But since I still wear my lingual braces, I would rather go through a second surgery asap, than have to start a new round of it in a year. I'm not afraid of this surgery anymore! Now, I know what it would be.
i can't find a good photo now either
-
it's "normal" but if you have to strain then it is not. also, if you are showing a lot of lower teeth, and less upper, that is not normal. people with open mouths (sort of looks hypnotic) tend to have a more difficult time with lip posture even with surgery.
strengthening the muscles is more likely to improve lip posture. surgery may only be a temporary fix. swelling can keep the lips together.
-
I have lingual braces so it wont really matter if they are there or not.
What is Medpore implants? Never heard about it.
When I look at some photos 3-months post-up I can see that it has improved a lot. Here's some photos. (I'm not sure how long I will leave them here)
it doesn't show that much here, shows much more when I talk. It's just weird -it's like my lips don't know where to be right now, cause it's unusual. Ha ha hypnotic yes, that's the word
how do I strengthen my muscles!? ;)
-
Hi,
Thought I could update this thread with my ceph predictions, after consulting with dr. Arnett since it might be interesting for people to see.
Summary of the movements:
Upper jaw downgrafted in the back with 14,4 mm and lower jaw advanced 28 mm + genio...
Anybody who has done such big movements and such a large advancement of the lower jaw, please pm me!
[attachment deleted by admin]
-
Summary of the movements:
Upper jaw downgrafted in the back with 14,4 mm and lower jaw advanced 28 mm + genio...
Wow!! But for sure you will need quite large movements. Other surgeons might not move things or rotate things as much as A&G but I think you'd wind up with big movements with any competent surgoen
Will you be getting a BSSO or an Inverted-L/IVRO? There is a guy with a very steep jaw like yours, can't remember the surgeon, and he got an IVRO with bone grafts for the gap
-
Wow!! But for sure you will need quite large movements. Other surgeons might not move things or rotate things as much as A&G but I think you'd wind up with big movements with any competent surgoen
Will you be getting a BSSO or an Inverted-L/IVRO? There is a guy with a very steep jaw like yours, can't remember the surgeon, and he got an IVRO with bone grafts for the gap
I will get a bsso. I have not seen any such large advancement on internet so would be interesting to see.
-
Hmm, this sounds like a big movement Snackan but it could be just what you need. Actually I'm quite jealous, I would love to have a big movement myself but I'm not sure I ever will. It could be a dream come true for you. Hopefully you go through with this because from my own selfish perspective I would love to see how things turn out. Maybe you will end up with a godlike jaw, who knows.
By the way, did you go to California for the consult?
-
Hmm, this sounds like a big movement Snackan but it could be just what you need. Actually I'm quite jealous, I would love to have a big movement myself but I'm not sure I ever will. It could be a dream come true for you. Hopefully you go through with this because from my own selfish perspective I would love to see how things turn out. Maybe you will end up with a godlike jaw, who knows.
By the way, did you go to California for the consult?
Yeah, i also think i need a big advancement, but its a bit scary when its so big. Hopefully it could be life changing in a positive way. Before all this i actually thought i had some kind of bdd, but when your face is that off it might explain it.
Why arent you going through with it?
Yes i did go to california for 10 day vacation and this consult
-
Summary of the movements:
Upper jaw downgrafted in the back with 14,4 mm and lower jaw advanced 28 mm + genio...
wow, how much were you quoted for all that?
-
Yeah, i also think i need a big advancement, but its a bit scary when its so big. Hopefully it could be life changing in a positive way. Before all this i actually thought i had some kind of bdd, but when your face is that off it might explain it.
Why arent you going through with it?
Yes i did go to california for 10 day vacation and this consult
I am going through with surgery. I've met with the orthodontic team once. I was supposed to meet the surgeon as well, but he was busy. I just meant that I want a big movement but maybe the surgeon will say 'oh, you only need 8mm' or something like that. In reality I think I need about 25mm or so to look normal. That's why I'm jealous of you, you have a surgeon who is willing to do that.
-
I am going through with surgery. I've met with the orthodontic team once. I was supposed to meet the surgeon as well, but he was busy. I just meant that I want a big movement but maybe the surgeon will say 'oh, you only need 8mm' or something like that. In reality I think I need about 25mm or so to look normal. That's why I'm jealous of you, you have a surgeon who is willing to do that.
Okey, so that?s like my first surgery. Pretty much no advancement, bad bite and no improvement in aestethics. Even if the surgery was free of charge, the cost in reality is actually worse (redoing the surgery) I hope your surgeon is good and will do what is best for you. Have you put any pictures/x-rays/cephs on the site? - could be interesting to see :)
Just want to add that I have not yet decided for sure yet that i will go through with surgery but I think I want to do it, but I will take my decision during December. I will need braces again, hopefully not to long though
-
Which guy was this, do you have a link? I agree with you about the movements. I think Arnett and Gunson underrate the importance of a strong chin. Strong chins really help define the features of a face better. Maybe they think 6-8mm genios look unnatural, but in my opinion they don't on the right patient. Sometimes it is exactly what is required.
Anybody who has seen an x-ray of genioplasty years after surgery when the bones is fully healed? - I mean will there be step-offs and what will it look like? Big advancement of the chin should result in pretty big step offs?
I might ask that next time I email them. I know one reason is because the muscles tend to get a lot thinner if you do to big genios. And also I guess Arnett/Gunson follow some kind of aesthetic "model", hence no need for bigger genios since they do counterclockwise rotation.
-
Just want to add that there probably are several suitable surgeons, Arnett is probably one of them at least in my case. I am not saying he is the best because I have not even had surgery with him and can?t know what result I would get
If I decide to go on with surgery I will see a couple of more surgeons, but it?s not that easy when you have to go abroad to see them.
-
Okey, so that?s like my first surgery. Pretty much no advancement, bad bite and no improvement in aestethics. Even if the surgery was free of charge, the cost in reality is actually worse (redoing the surgery) I hope your surgeon is good and will do what is best for you. Have you put any pictures/x-rays/cephs on the site? - could be interesting to see :)
Just want to add that I have not yet decided for sure yet that i will go through with surgery but I think I want to do it, but I will take my decision during December. I will need braces again, hopefully not to long though
I don't have any x-rays/cephs, I'm not even sure what a ceph is really. I think I had one taken but I'm not sure. I saw the x-ray results when I was sitting in the dentists chair having moulds redone. No mention was made of me getting my own copies or anything. I could ask I suppose but I'm not sure I will bother. I have no idea what the surgical plan will be.
-
Greetings to all! Luckily I found recently this forum. I underwent 9 months ago under a double jaw surgery and a revision surgery. My first question, if anyone can help me, is related to a fact that a recently discovered after I got my CBCT scans from the surgeon's offices: during my first double jaw surgery they fractured my right mandible ramus. I am attaching a photo so you can see. I never knew about this fracture. But also important is how they were able to fracture my mandible's ramus like this during my surgery? Any thoughts?
[attachment deleted by admin]
-
Greetings to all! Luckily I found recently this forum. I underwent 9 months ago under a double jaw surgery and a revision surgery. My first question, if anyone can help me, is related to a fact that a recently discovered after I got my CBCT scans from the surgeon's offices: during my first double jaw surgery they fractured my right mandible ramus. I am attaching a photo so you can see. I never knew about this fracture. But also important is how they were able to fracture my mandible's ramus like this during my surgery? Any thoughts?
Strange it´s not possible to see the cut below the plate. I am just guessing now, but it could not be a massive amount of grafting material? - I don´t think I am right but if I am there is no fracture on your ramus. Did you have problems with your joints before the surgery? Was Gunson your surgeon?
Seems like you had a great result, perfect bite and seem to look really good - would be interesting to see before pics/x-rays/CBCT scans
-
"Strange it´s not possible to see the cut below the plate. I am just guessing now, but it could not be a massive amount of grafting material? - I don´t think I am right but if I am there is no fracture on your ramus. Did you have problems with your joints before the surgery? Was Gunson your surgeon?
Seems like you had a great result, perfect bite and seem to look really good - would be interesting to see before pics/x-rays/CBCT scans"
Sorry to disappoint you, but that crack that you see on the ramus (vertical part of the mandible) is a fracture and it was confirmed by other doctors. My only surprise was how one can fracture that bone since it needs a lot of power applied. Also, from profile, the results might look good but frontal view and in real life, the surgery was a disaster (mouth twisted, no tooth show, no occlusion etc.) and I need another surgery to correct all these and to achieve the initial objectives that were never achieved. A CT/CBCT scan look doesn't necessarily match the real appearance that you get after surgery, so be careful if you will try to assess your future results based on how the CT scan looks like. You might get negatively surprised, as I was.
However, I never had TMJ problems prior to surgery. I do not know who Gunson is. Is he a surgeon? Could you tell me about him? Unfortunately I cannot give you on a public forum the name of my surgeon, but if I knew what he will do on me I was never submitting myself to his "skills". And I would not recommend him either.
-
"Strange it´s not possible to see the cut below the plate. I am just guessing now, but it could not be a massive amount of grafting material? - I don´t think I am right but if I am there is no fracture on your ramus. Did you have problems with your joints before the surgery? Was Gunson your surgeon?
Seems like you had a great result, perfect bite and seem to look really good - would be interesting to see before pics/x-rays/CBCT scans"
Sorry to disappoint you, but that crack that you see on the ramus (vertical part of the mandible) is a fracture and it was confirmed by other doctors. My only surprise was how one can fracture that bone since it needs a lot of power applied. Also, from profile, the results might look good but frontal view and in real life, the surgery was a disaster (mouth twisted, no tooth show, no occlusion etc.) and I need another surgery to correct all these and to achieve the initial objectives that were never achieved. A CT/CBCT scan look doesn't necessarily match the real appearance that you get after surgery, so be careful if you will try to assess your future results based on how the CT scan looks like. You might get negatively surprised, as I was.
However, I never had TMJ problems prior to surgery. I do not know who Gunson is. Is he a surgeon? Could you tell me about him? Unfortunately I cannot give you on a public forum the name of my surgeon, but if I knew what he will do on me I was never submitting myself to his "skills". And I would not recommend him either.
Was your surgeon belgian by any chance?
-
"Was your surgeon belgian by any chance?"
Hi! My surgeon was not Belgian. It is a "great" NYU surgeon and Professor...blabla bla...Recently I found out from other doctors that what I couldn't see on CBCT scan is indeed MISSING! After he fractured my ramus during the first surgery, during the second surgery he removed the part that cannot be seen on the CBCT scan. I thought I was fainting when I heard what happened to me without knowing. This is mutilation. No occlusion, facial asymmetries acquired and now, the missing part of my jaw and my right condyle ou of its fossa . "Great job" at NYU Langone. All they care is the money. Extremely disappointed. I do not know who can fix me now. My surgeon at NYU Langone was Dr. Eduardo DeJesus Rodriguez. For more information you can visit my newly start webpage:
http://failedorthognathicsurgeries.weebly.com/
[attachment deleted by admin]
-
My original plan was LeFort I 3-piece for widening my maxillary, BSSO and genioplasty. Instead I got LeFort 1-piece; I found out this from my treating orthodontist in April. I did not need IVRO. My TMJs were healthy and well positioned. I never expected such "results" and now I am in constant pain in the roof of my mouth, on the right side of my skull and sometimes in my left ear, and I connot chew properly due to the acquired malocclusion. In fact, I found out about the missing bone too late, this summer, whereas my surgery took place last year. I cannot finish my orthodotia because I need another double jaw surgery. I hoped that I would find some advice on this forum and see how people dealt with such issues, or people who had my kind experience. I am looking for a medical solution. To the other questions that you posed: No one from the hospital wants to answer to me to my medical questions anymore. Pure silence. So, if anybody can help, I will be very glad. At this point, personal photos I cannot post for privacy reasons but I can post pre-op CBCT scan image.
[attachment deleted by admin]
-
You should really make a separate thread to bring attention to this and not piggyback on a thread whose subject line has nothing to do with your case. Just trying to be helpful :)
Dr. Gunson is Dr. Arnett's partner and they have a facial reconstruction/jaw surgery practice together in Santa Barbara and are pretty well known on this forum. This was also my surgeon as well. If there's any issues you're dealing with, I'm confident one of them will be able to help you out.
-
Thanks for the good advise!
-
UPDATES: My surgeon at NYU Langone was Dr. Eduardo DeJesus Rodriguez. For more information you can visit my newly start webpage:
http://failedorthognathicsurgeries.weebly.com/