Do I need jaw surgery or implants/fat transfer?

[pumukka]

Ola everyone!!

I've been following the jaw surgery forums for a while but only now I decided to post. I'm confused to whether I need "mild" jaw surgery, implants/fat transfer, I see my self as cute and I don't have a very noticeable problem thought.

I was supposed to have jaw surgery (Osteotomy retrusion + genioplasty) about 7 years ago. I had a Class III, my incisors touched flared edge to edge. Instead I had 4 bicuspid removed and just braces cuz I was giving the impression by another orthodontist that we could also fix it without surgery cuz back then I wasn't as informed   which I deeply regret now cuz even if that orthodontist did an amazing job at camouflaging it, I think I would have had a much better result fixing the problem,

I see my mid-face a little dish in / flatter, flared incisors and narrower V arch, maxillofacial/plastic surgeons also told me that my paranasal area mid face doesn't project much either and this is what some of them recommended:
 

-Braces+Surgery, having 2 cuts behind my fangs to bring biprotusion backwards and make arch shape wider.
-Braces/invisalign a few months to close the gaps, and later get cheek and chin implants (maybe paranasal too?)
-Fat transfer from the side of my cheeks to the front per say, get braces too.
-Braces+surgery, just moving my lower jaw back
-I look fine, even my flared biprotusion looks good or he didnt even see the biprotusion / lower jaw I'm talking about
-Get the teeth straight by braces first and we'll talk about the getting either surgery or fat transfer / implants after braces treatment ¿?

Confusing right!? I don't want to make this a super long post no one wants to read lol, but I'd appreciate if you could check my pics and a few posts where I have more detailed info about all this in my blog if you got time. http://thestoryofmyteeth.wordpress.com/

My main concern is giving my mid-face projection and have nice cheeks like I used to had but I'm not too keen on implants, and fat transfer is not permanent and you cant put that on the paranasal area, I'd love to have a much wider U or C smile like before too, I read about reopening the bicuspid extractions spaces, but everything seems like so much work to undo when everything would had been easier had i done it before.. it also seems like a steep gonial angle in some pictures but my oclusion is more horizontal, or maybe is a narrow vertical ramus or narrow jaw? uggh

Here's some pic from before, now, and a few modifications, bigger size at my website http://thestoryofmyteeth.wordpress.com/my-pictures/



My case is so mild borderline so I wasn't sure if I had to post this on a plastic surgery board or jaw since it might be a bit of both, have I lost my chance of having the "nice face I wanted" because I didn't had surgery when I was supposed to?

This is what my very detailed exam report said:

    A little maxillar hypoplasia,
    Mandibular hyperplasia,
    Mesodolichofacial skeletal pattern, lower third augmented,
    Augmented vertical height (long face?)
    Jaw deviation to the left I guess from asymmetrical condolys and asintomatic TMJ which made my jaw a little canted (one gum  shows more on one side than the other)
    Right maxilla side crossbite, small lip incompetency,
    Right middle line shifted
    Flat chin
   
Tons of things even if I didn't look bad!! that's why I'm worried if I'll still have an underlined jaw issue or future problems or do you think it kinda has it been "corrected"?


Thanks!! ps. sorry english its not my first language

[pekay]

Orbital rims look slightly deficient as well.

If you do decide to take the surgery route I'd recommend orthognathic surgery over implants & fat grafting/fillers

[pumukka]

Thanks guys, I consulted with 4 surgeons those were their options above, each one gave me a few different options and I'm so confused!  

Those are the movements I did on the modified pictures and I think it looks much better, but they said because I have a class I occlusion already is more complicated, I believe maybe reopening the spaces and re implanting the bicuspids will give me even more cheek projection but most of them just want to take a non-complicated approach.

I definitely dont want implants, and fillers is an extra cost every x years and I'm not sure where will they take the fat from cuz I'm skinny lol. I'm waiting for a reply from Mommaerts at the moment but I read hes quite busy. I've seen another very good surgeon which id totally trust skills but since he kinda said "I'm fine" we might have different aesthetic views and so that might not work..

I want to contact him again last to see what he says again, maybe he just wants to make sure surgery is what i want, it was the first I went to see but I didnt bring x-rays with me and he only toke pictures of me, I had a little bit of make up too, although he should still notice even with that?

[pekay]

Well I'm no dentist or anything but I think your case seems slightly complicated due to the 4 bicuspid extraction that you had and the fact that you're now a Class I bite (minus 4 teeth) with a Class III dental skeletal malocclusion

I see that you're Euro based, have you tried consulting with Dr. Hernández Alfaro? according to an e-friend of mine Prof MM is overbooked for months to come.

[treevernal]

Class 3 or not, you have a beautiful jawline.  I was jealous of people like you for years!  Best of luck to you

[Marisama]

I agree. You look great. See what a few surgeons say. Go to more than one! If you have functional issues, that alone is reason enough for surgery. My TMJ issues have basically been fixed with double jaw surgery.

[pumukka]

an orthodontist mention CCW cuz I mention my gonial angle too steep. (But by bringing the lower jaw back would make it seem shorter, plus my oclusian plane is quite "horizontal" already) This one mentioned the orbital too and said I might make my eye dark circles less noticeable.

The orthodontist that said to fix my biprotusion/flared teeth backwards with braces/invisalign mention something that after that, the surgeon can move or rotate jaws together. However his surgeon first told me about moving the jaws and even grafts, when I first went to see him, then he said im pretty and doesnt know if i should do surgery, fine till then,
but then he tells me to call him and is busy,doesnt call me back, so i have to ask the ortho whats the story, they said to do the otho treatment first and then "we'll see what can be done after that,"

They are very good doctors but that doesnt give me much confidence, I know what I want, more mid-face projection etc, so retracting everything and moving together the jaws might not be what im looking for, or maybe it is, but since the surgeon doesn't get in contact with me nor returns my calls..

Shouldn't I talk with him and know whats the final outcome to see if its what i have in mind be before I even starting braces? what about occlusion, soft tissue movements, airway and costs are very important too. Even if hes one of the best and will make it better, I already trusted my face to someone without going into full details and i wont do that anymore, i want to know everything before hand


CW I think would work for my mid-face and flared teeth, even tough braces and invisaling study shows them they can be brought backwards very nice (altough im not sure how accurate the invisalign clincheck design.

With CW can they still shorten the lower jaw so it will not be so long and steep? I saw pictures from a girl that had a class III with very steep gonial angle, and even tough she looked gorgeous after (you could see she was very pretty already) her gonial angle didnt look very natural even more steep

[pumukka]

I know, I have small gaps where my bicupspids used to be cuz I lost my retainer so maybe I could open them again and put implants even if it takes longer.

Alfaro was the first I went to see, hes one of the top, I'd totally trust his hands IF we were to agree on the same aesthetics. I need to send him x-rays and this pics, cuz maybe in the ones they took since I had make up and maybe I was posing, Im so used to pose in pics i dont even notice if im doing it,

their place is amazing! top technology too. but its a bit out of my budget, they better give me gourmet food if I get it done there! oh wait I wont be able to eat.. lol  gourmet milkshake hehe 

Thanks! I need to cheek the TMJ cuz it might be a cervical problem the neck base pain? 

Sorry for the long replies!! hehe Im very chatty hehe,

[stupidjaws]

pumukka, i still haven't read anything (only saw photos).

You look beautiful. I would NEVER get jaw surgery if i were you!! NEVER.

[pumukka]

Thanks! hehe, its a super long post but if you could read it when you got time hehe. I'm not ugly and I have a nice bubbly personality, but I do have a diagnosed skeletal Class III, id like to try do some modeling but they always tell me to just face front cuz of my dish in mid-face makes my jaw problem even more noticeable on camera.

I can live like this and dont even get implants/grafts but, I do look much prettier on the modified pictures and would help my career a lot. Just like if i wanted to do glamour/topless modeling and had noticeable asymetric boobs I'd probably get a boob job, not that jaw surgery is anything like that! its just an example lol

I regret so much not having the surgery when I was supposed to  Id like to improve my appearance but i dont want anything unnatural inside my body

[stupidjaws]

If you really want something done your only viable option is jaw surgery. All the rest would not improve a tiny bit.

[falcao]

I agree you look great to begin with, and I think that makes your decision even harder, as there is much to risk. Can I ask you who else you saw apart from Alfaro? He was the first one I saw as well, and although I was very impressed with him and his staff, I sadly realized I can't afford him. I'm seeing MM in the beginning of April.

[Modigliani]

How expensive is Alfaro?

[falcao]

I need single jaw surgery: Total cost for mandibular advancement (with some clockwise rotation) - and nothing else - about 18,000 euro ($24,000). Now you can imagine what type of quote you can expect if you need anything more complicated than this (double jaw...).

I got indication from MM - total cost for mandibular advancement + genioplasty = about 8,000 - 10,000 euro.

Now, I'm only hoping he's not reading this, as I still haven't got my quote  That man almost doubled his fees in the last 18 months or so (about 100% increase). I don't know if that is due to his reputation on surgery forums and the fact that patients from other parts of the world (I know even a few Aussies) go to consult with him. If he quotes me significantly more than initially indicated by his receptionist, I'm going to Costa Rica. I will have no other option. Besides, it's hard to find any pictures of the work he's done, apart form his web site, where you can see some very old and low quality pics that don't really tell me anything. I hope he'll be able to show me more in his office, but I don't know if that is even legal in Europe. At least I can find out how many orthognathic surgeries he does per year and what is his overall experience. Any other general questions I should ask (apart from the specifics of my case, of course)?

To the OP - sorry for this lengthy offtopic answer - I felt obliged to respond to the above poster's question.  

[Londonlen77]

pumukka, If i were you I would keep as you are you look Great , It does not always work out
as you want , you look great you say you are asymmetrical , to Be Honest I can't see that
 you have a Fantastic jawline and a very Beautiful Face.