jawsurgeryforums.com
General Category => Emotional Support => Topic started by: mazilla on October 20, 2017, 02:16:28 PM
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These are the numbers for my double jaw surgery for an overbite. What do you guys think?
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These are the numbers for my double jaw surgery for an overbite. What do you guys think?
What kind of response are you expecting with a bunch of numbers and no visual information?
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I just want to know wether those numbers are super high or not. I don't even understand well those numbers but looks like almost 2 cm advancement, isn't that huge?
Looks like about 1 cm for maxilla and 2cm for mandible. It would correspond to someone needing a LARGE advancement. You would have to post a PROFILE shot (ceph) for someone to eyeball an approximation relative to the proposal.
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I had this surgery done already. I just think my maxilla and jaw were moved forward too much, so now I don't look like myself or my family anymore. My surgeon says I just need time to adapt, but surgery was 2 years ago. I think that 1 cm maxilla and 2 cm jaw movement is just crazy, they should warn people before making such huge advancements that they won't look like themselves anymore. I am considering a revision surgery.
I would like to talk to people that are stuck in the same situation as me.
That or just perhaps people could inquire for feedback BEFORE the surgery WHEN the numbers are proposals .
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They gave me those numbers the day before surgery, and because I asked him, we would have given me nothing otherwise. I did not have a proper proposal from the doctor, he just said that I needed double jaw surgery due to an overbite and sleep apnea. I just trusted him. I guess I f**ked up with that. You meant asking for feedback on this forum, right? People would have probably said those numbers are awesome, because most people here complain about their surgeons having advanced too little...
To be honest I didn't even know that I needed a proposal. I visited 4 different surgeons and all 4 of them said the same thing: you need double jaw surgery. The thing is that the surgeon I chose decided to advance my face like a maniac. I never imagined that my face would change SO much. In all the before and afters I had seen on his website, people look pretty much like the same person, just better. In my case the advancement was so huge that some people don't recognize me and I am having a lot of trouble getting used to this face, and not looking like my family anymore.
Yes, I meant asking for feedback from this forum. Intelligent people would have asked to SEE a ceph at least for aesthetic feedback regarding the extent of the advancement to both jaws even if you had no numbers.
NOW that you relay you had sleep APNEA which you did not share prior, that changes the equation and explains why you may have had MORE advancement than you would like. They have to advance however much is needed to give the air way plenty of room which is some cases, ends up being more advancement than it would be if you didn't have apnea.
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Here is a review regarding a Lefort 1 revision surgery.
The girl complains about her lip : sad expression causing by the set back of the upper jaw.
I don't know if it happens systematically but, be careful.
https://www.realself.com/review/portland-orthognathic-surgery-advise-lefort-double-jaw-surgery-lefort-revision?tags=8087&rating=unsure&offset=2&sle=0
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I understand, but maybe with less advancement I would have had enough room to breath right? My sleep apnea was moderate.
What is considered enough room? That is pretty relative right? Also, could it be that the surgeon overcorrected in case there was a relapse in the future? Does that happen? Im 30 btw.
I just feel that was way too much advancement and I don't recognize myself. Would it be wise to do a revision surgery to move back everything a little so that I feel like myself again?
I DON'T know and how could I know HOW MUCH room you needed for your airway to have the space it needed??? What info very SPECIFIC to YOU do you think I would have (like a ceph) to know this??? What I know is the GENERAL info which is that when APNEA is a key factor, they sometimes need to move in EXCESS of that they would otherwise move if one didn't have the apnea. Also, double jaw surgery, except for die hard narcissists or BDD types who would get it just for a few millimeters that no one else would notice, is rarely a subtle change and mostly a DRAMATIC one even for those who don't get it for apnea.
Although I know a LOT about aesthetics, such knowledge is neither here nor there in the absence of any visual information of a person inquiring about aesthetics.
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Thanks Kavan.
Of course I know you wouldn't know how much advancement I needed.
I know double jaw surgery is usually a big change, but 2 cm??? I haven't seen anyone here getting 2 cm advancement. I feel like with maybe 1 or 1,5 cm he would have opened my airway just enough and I probably wouldn't look so different. 1 cm is already a lot isn't it? 2 cm seems crazy to me.
I feel like my jaw is where an underbite jaw would be, just that I don't have an underbite because he also moved my maxilla to match that movement. Also my jaw line looks like the jaw line of a person with an underbite...
It's a significant advancement. But I can't tell you if it's right or wrong for the medical condition it was done for. But i understand it's too much for you aesthetically and personally.
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Thanks for your understanding Kavan.
My surgeon either does not understand it or doesn't want to admit he made a mistake.
Now, do you think considering a revision to move my maxilla and jaw a little backwards (only if my airway would not be compromised) is reasonable, or since I don't have any complications and my airway is now open I should forget about it due to the magnitude of the surgery and its potential complications?
The conservative choice is the latter, keep as is. Maybe it looks good from the perspective of other people who don't know you. Might not be a bad idea to take some time off and go somewhere where NO ONE knows you and see if you get a good reception based on new appearance.
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I do get a good reception from people that didn't know me before surgery, and they don't think that my jaw is too much forward. Only myself, my family and friends believe that.
But getting a good reception from people I don't know doesn't make me feel any better about me not looking like myself and my jaw being too much forward to the point that I can't shave my beard. With beard it looks fine, but when I shave its when I look weird: bimax protrusion, underbite jawline... Its like the beard gives shape to my face, but the shape is awkward with no beard, like an underbite with matching maxilla. I don't know if Im explaining it well.
Am I not going to be able to shave ever? I don't feel good with that...
Well, then it probably looks good to other people and maybe better than prior. i think you just have to get used to it.
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Can you post some pictures (x out your eyes, etc) or at least a tracing?
It's hard to say much without seeing it.
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I'm kind of in a similar boat. I was class iii before surgery, just a 6 mm maxillary advancement changed my profile from concave to convex. It just looks "wrong". My upper lip, maxilla now dominate my face. Facial hair is my only recourse. Unfortunately it makes my paraesthesia 10 times worse.
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Kavan and GJ, I can send you guys a pic in a PM
Can't speak for GJ. But as a general rule of thumb, mods have a lot on their plate (board chores to keep order etc.) and/or like the aesthetic commentary/advice etc. to be in the open venue unless the member is approved to be on the private section of the board.
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How can I be approved to be on the private section?
Usually a good track record of posting history, being a known person where the mod knows you well enough and a donation.
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There's really not much harm in putting up a profile shot for a few days, black out however much you want.
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Ditterbo, I really don't want to post my pics online, sorry.
More info about my surgery, I want to know if these things are common.
-I never got a proposal from my surgeon
-He said he would decide on the day of the surgery wether I needed genio or not depending on how the surgery went (he ended up not doing it)
-I had deviated septum so he performed a septoplasty. He removed my anterior nasal spine (he does not admit it, he sais it was missing before surgery, but that is not true) as a result my nose is flat. Is it common to remove the anterior nasal spine while performing LF1 and septoplasty?
-My gums on the left side receded a lot with the surgery. Does that mean bone loss? Why does that happen?
-He segmented my maxilla on that same left side, but left it in the same position and left me with an open bite on that side that had to be fixed (partially, its not 100% closed) by the orthodontist (this was surgery first, but I had no open bite pre surgery, only class II malocclusion, receded jaw and maxilla and sleep apnea).
No Photos:
No photos=NO aesthetic advice= don't bother asking about such or even expect your self assessments to be visually cross referenced by others. No photos= DON'T ASK whether this or that mm displacement was 'too much' for YOU specifically.
Proposals:
A proposal arises from a full WORK UP where cephs are taken. A ceph analysis is then done. After that a ceph DISPLACEMENT analysis is done which shows the original ceph tracing with an overlay tracing of HOW they wish to CHANGE things along with a read out of the displacements. A proposal can constitute a SURGERY PLAN. Doing all the DIAGNOSTICS that need to be done for such a surgery PLAN/proposal is TIME CONSUMING and are not just 'automatically' given out by each max fax one consults with. IF and WHEN they are, the CONSULT with the max fax can be LONG and in the $500 range. Patients 'shopping around' for a max fax wanting to get a surgery proposal USUALLY need to PAY (extra) for it. Patients wanting to compare plans/proposals from a number of max fax docs, usually ASK for them FIRST. Subsequently, the PRICE to DO is given to them.
Perhaps Ditterbo can tell you more about the costs of his consults WITH surgery proposals.
ANTERIOR NASAL SPINE:
It is common for it to be MOVED with the lefort 1. Better double check whether yours was MOVED or 'removed'.
SURGERY FIRST TECHNIQUE
It is common to be left with a NOT SO GOOD bite that requires 'fixing' AFTER the surgery. SF, the whole point of it, is to have the ortho LATER.
WHAT IS COMMON:
The most common complaint with sleep apnea surgery is advancement in excess of what it would be IF someone were NOT getting the surgery for apnea. So advancement BEYOND what is aesthetically optimal is the MOST common complaint associated with bi-max solely for apnea.
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Thanks Kavan,
No photos: In my last message, none of my questions were related to aesthetics, but Id like to access the private forum if that is possible.
Proposal: I understand what you are saying. Before surgery, I though that jaws had an optimal position and mine were not in that position, so the doctor would just put them were they were supposed to be. I went to 4 different maxfacs and all 4 of them said I needed a bimax, but I didn't ask for a surgery plan. Then I decided which doctor I preferred (just based on his reputation and his before and afters) but he never told me how much he was going to advance my jaws or whatever he planned on doing. So my question is, do people never get a surgery plan or proposal unless they ask for it and pay for it?
ANS: My ENT sais that my maxfac removed it, and he asked my why. I have no idea why he did this. After the surgery my maxfax said that it was missing... My nose is completely flat now. Is this fixable?
Receded gums: Why does this happen? Is it due to bone loss?
Common:
That is my main complaint. I feel my jaws were moved way too much forward, but I am not asking you guys if you agree, because obviously you would need to see my pics. That and my nose being flat because of ANS removal make me regret my surgery. I didn't know this was a common complaint about sleep apnea patients. My sleep apnea was not very severe, so I wished they didn't move my jaws past the optimal position, and left my ANS where it was. That would have been a good surgery outcome for me, because that probably would have been enough to cure my mild sleep apnea.
I was a mouth breather my whole childhood, I believe that is why my jaws didn't fully develop. I just wished that my jaws would have been advanced to the point where they were supposed to grow to, not way past that point. And I don't get why he had to remove my ANS. The huge maxillary advancement added to the ANS removal left me with no nose and bimax protrusion :(
mazilla,
I understand that you don't like/are unhappy with your post operative appearace. I understand that because i know bimax for sleep apnea has capacity to over advance because it's done in accordance to something you CAN'T SEE on your face which is the AIRWAY. Not to mention it's not uncommon for bimax, even for people not getting it for apnea, to be a DRAMATIC change.
But beyond understanding that you are unhappy with the results, there is not much aesthetic advice that can be given to you in absence of any visuals.
There are also cases where people are very USED TO how they look and EVEN IF the surgery makes them look BETTER (to average onlooker), their attachement to what they are used to seeing over rides what could be considered attractive by others. Not only are you attached to how you used to look but you are also attached to the belief that your doctor did something 'wrong'. To that regard, your ATTACHMENT to your own opinion supercedes anything anyone here can say to make you feel better about your outcome. Afterall, you're not looking for re-assurance that it looks like an aesthetic improvement by others. Nor if it it looks worse by others. You just want to assert your assessment. Your posts just REPEAT your own assessment. Although you are entitled to your own assesment, it's NOT grounds for entry to the private forum.
As to your nose being fixable, most likely YES, by a good rhino doc where septal grafts would need to be constructed to build tip and base of the nose support. As to the ANS being 'missing', you would need the CEPH to evaluate. So, get a hold of that and have both the max fax the ENT show you on it where it was 'gone' or present BEFORE the surgery. Failure to provide a ceph on HERE precludes any feedback on whether or not it was there or not.
If you just want to re-assert your assessment in the absence of any visual info for which others could give you feed back, perhaps the 'Emotional support' section would be better place to post and perhaps to attract other posters who are good at emotional support. I'm just BRASS TACKS knowledge, information, aesthetics.
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Kavan,
I never said I look worse post surgery. In fact, I believe that I look better.
My complain is that I look too different! And that could have been avoided by not advancing my maxilla 10mm and my jaw 19mm, and not removing my ANS. Sure, my surgeon advanced that much in order to open my airway as much as possible, but I am sure I did not need THAT MUCH advancement, I believe he just wanted to really make sure my airway was properly opened so he exaggerated the movements. Probably half of those numbers would have made the trick. 5mm maxilla and 10 mm jaw with CCW would have opened my airway A LOT already.
So, I believe that I look better, but not optimal, and I believe that I look too different, which bothers me a lot because I believe I don't look like myself nor my family anymore.
Also, I don't want to only assert my assessment. I wanted to know if some of the things that happened in my surgery are common or if it was the surgeon's mistake.
Also, I do want to know the opinion of other people about my aesthetic result. Just not here. In PM or the private forum would be better. I want to know if more knowledgeable posters believe that I was over advanced, or if it is only in my mind because, as you say I was too used to my old face. About my nose im pretty sure he ruined it removing the ANS.
Thanks
I told you what was common--common for more advancement than wanted when it's for sleep apnea. in the absence of visuals, we don't discuss mm advancements. They are neither here nor there in absence of visual info.
Not sure how you determine which posters are 'more knowledgeable' but you are certainly invited to ask people to PM you if you don't want to show any open photos.
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I'm kind of in a similar boat. I was class iii before surgery, just a 6 mm maxillary advancement changed my profile from concave to convex. It just looks "wrong". My upper lip, maxilla now dominate my face. Facial hair is my only recourse. Unfortunately it makes my paraesthesia 10 times worse.
The worse thing about paraesthesia for me is shaving. OH HOW I HATE SHAVING.
It feels awful even though it's not painful or anything. I think it just annoys me because it reminds me of everything I've been through and how much more I'm still going to have to go through.
And also it means I HAVE TO LOOK IN THE MIRROR FOR 15 MINUTES TO DO A GOOD JOB AT IT.
f**kING ARGHHHHHHHHHHHHHHHH
If I looked good with a wild beard I would just let it grow wild so I never have to do that ever. Both aspects suck. I hate shavers. I hate mirrors. The combination is crap.
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I believe a surgeon has a responsibility to balance aesthetics and functionality when performing these procedures for sleep apnea. I had a 14mm advancement, despite my objections to that because the projections looked bad, and was told that the projections were estimates. But, the projections were accurate. I don’t look good - it’s cause for malpractice!