advice about suitable surgery? (pic)

[snufkins]

Hi,

I was just wondering if anyone had the time, if they could view my pictures and suggest their opinion best type of surgery that exists  to correct my problems? I have a very wide jaw & chin that is also far too long vertically but I also believe my jaw may be slightly recessed. I don't know any of the correct terms for my problem.
I don't know if I fall under the "long face syndrome" category or not but I have noticed my right side of the face is alot more severe than my left.
I have been in braces for about 5+ year plus in the past and I believe this possibly made my problems worse, eitherway I have nothing to show for it as my front teeth are overlapping & crowding again.

I went down the NHS route a few years ago about jaw surgery but I didn't really quite understand my problems as much as I did then and they kind of shooed me away in the end whilst labelling me with bdd.

I have looked at surgery in south Korea as I would really like a slimmer chin & jaw line - that "v-line look" as well as my chin being reduced in length vertically. Aesthetically I really love what they achieve but I'm not sure travel to this country for surgery is going to be realistic ??

I have consulted with Caroline Mills, she seems to think any sort of double jaw surgery would be too drastic or not necessary and suggests genio and I have also talked to Mommaerts through email - he suggests " this is a chin impaction + narrowing and a Triaca chin wing to address the posterior part and the mandibular angle. It is technically very demanding surgery " if anyone can enlighten me what that surgery is or entails? As their new terms to me.

But yes I won't go on, as of current I'm still at a loss of what way to go about things, I plan to try and get a consultation to see Mommaerts early near year however.


http://i44.tinypic.com/2exsow4.jpg  ( xray )

[snufkins]

Regarding the genioplasty I meant as a reduction, I  think they take a wedge of bone out? rather than the ones that slide forward.
However my concerns are the soft tissue, if my jaw is slightly recessed - as it seems to be as I already have alot of soft tissue under my chin ( doesn't seem to be much projection, I might be wrong? ) if I have my chin reduced will the skin just sag? thats why I'm a little worried about just a straight reduction, I don't know if something more needs to go on to prevent that - such as jaw surgery.
Caroline did mention about moving just the chin forward, but like you say in that picture it's already out far!

My dentist has mentioned when my wisdom teeth come through they will have to be removed as I literally have no room in my mouth, prior to braces I had 4 teeth removed if thats what you're refering too regarding teeth!

[pekay]

It does seem like you have VME without a gummy smile (deep bite), you probably need posterior impaction to correct that (although I could be wrong)

I wouldn't go to S. Korea if I were you, you're bound to get the cattle treatment there.

[Tiny]

Yes, that site is Paul Johnson.  When I consulted with him I threw a LOT of questions at him and he was fine with everything - some surgeons would have got pissy.  He's quite mild mannered and not the arrogant god-complex type (I got a bit of that vibe from Thuau).   Also Jonhsons fee includes Xrays.

The quote I got was 7k GBP for bimax and 5k GBP for ortho.   Timeframe depends how long you need in braces beforehand

Do you have an NHS ortho?  Can they refer you to a jaw surgeon?  Some people on here have had their surgery on the NHS at one of the London teaching hospitals

You might need palate expansion if you have a lot of crowding but I'm not very knowledgeable in this area.  Certainly it would be best to avoid additional extractions

[Lazlo]

reading through this thread carefully, i think your situation is complex since you've already had a lot of ortho work done. definitely consult with 3-4 of the top docs and try to understand as best you can all the possible solutions. I can't really tell but it almost looks like you have a narrow maxilla and if you have trouble breathing you may have quite a recessed one as well. You do have the raw materials to achieve an above ordinary and beautiful result. Most people have not enough jaw bone, with your surplus, you could be sculpted into something quite striking.

[snufkins]

Yeah, I get that sort of impression also and it puts me off that he apparently doesn't show previous patients before & after photos at all.
Is that the quote from Paul Johnson? Doesn't sound too horrendous if that includes everything? Certainly less than I feared, although mine might be different ofc.
I did have an NHS  orthodontist but my general dentist was private, I don't really have any connection with the orthodontist now as it was quite a few years ago now that I finished my treatment. I however have been referred in the past by my docter to a hospital regarding jaw surgery and it was rejected on the terms they thought I had bdd about my appearance & it probably didn't help that I didn't fully understand the problems regarding my face and what may have caused them but also I was a "borderline" case, so being how tight the NHS is now days I don't think it will be possible that way tbh.

My private dentist has mentioned palate expansions in the past, as well as fillers ugh because my face is quite narrow - I suppose it is but I think the fact my lower jaw and chin is long and my lips very small exaggerates it.

When jaw rotation is mentioned how is this exactly achieved, what type of jaw surgery is this called?

[Lazlo]

Yeah, I get that sort of impression also and it puts me off that he apparently doesn't show previous patients before & after photos at all.
Is that the quote from Paul Johnson? Doesn't sound too horrendous if that includes everything? Certainly less than I feared, although mine might be different ofc.
I did have an NHS  orthodontist but my general dentist was private, I don't really have any connection with the orthodontist now as it was quite a few years ago now that I finished my treatment. I however have been referred in the past by my docter to a hospital regarding jaw surgery and it was rejected on the terms they thought I had bdd about my appearance & it probably didn't help that I didn't fully understand the problems regarding my face and what may have caused them but also I was a "borderline" case, so being how tight the NHS is now days I don't think it will be possible that way tbh.

My private dentist has mentioned palate expansions in the past, as well as fillers ugh because my face is quite narrow - I suppose it is but I think the fact my lower jaw and chin is long and my lips very small exaggerates it.

When jaw rotation is mentioned how is this exactly achieved, what type of jaw surgery is this called?

it's just a component of jaw surgery (usually bi-max which means both jaws, since you can't rotate just one). You can have a more or less "linear" advancement where both jaws are advanced but in a linear vector. Or both jaws advanced but along an arc, counterclockwise (think of the jaw as spinning on the face of a clock) and the advancement is achieved not so much with a forward movement but through rotation. You need a really good surgeon --if you have the funds, I'd even consider consulting with Arnett/Gunson just to get a treatment plan from them (will cost about 500 bucks) and then have a really good surgeon follow it. Dental expansion sounds like a very good idea for you. Don't mess about with fillers till you have the jaw structure sorted out. Think lips can look very good, elegant if on a face with the right proportion. Don't worry, you have very attractive features, so you're lucky, it's better to have excess jaw/bone issues than a deficit because it means your result can be sculpted to a very aesthetic degree.

[joedavis7]

Just to let you know, I spent a lot of time with Caroline Mills and her orthodontist colleague having X-rays and discussions on the treatment they could offer etc. I really wanted some asymmetry addressed at the same time as having a lower jaw advancement but she seemed reluctant to do it which has put me off. To be honest, I don't know whether it was because I was expecting too much or that she was simply being realistic with what was achievable. However, She's certainly a nice lady and worth having a consultation with.

By the way, I will be getting some additional opinions soon from Manolis Heliotis and maybe Paul Johnson.

[snufkins]

I have an appointment with Noorman van der Dussen at the end of this month, I don't know if anyone is familiar with him here, but I thought I'd go for a chat as I know he does a lot of FFS surgery so thought he may have some expertise on reducing the jaw/chin area, just to see what he says.
Quite interested to see the new thread about the Chin wing osteotomy as mentioned Mommaerts recommended this to me before & didn't quite understand what he meant by this.

I agree Joe, pleasant, but probably too conservative in what I'm trying to achieve (most certainly if going by the before&after pictures she had shown me)
She didn't really offer me much insight other than reduction genioplasty and also bringing my chin a bit forward to address my concerns on how I don't seem to have much projection away from my neck( which I believe may be because my jaw is recessed??) Advancing my chin alone would be disastrous as shown in the pictures it's already quite prominent. So didn't like her recommendation there, she didn't seem to want to discuss any sort of jaw surgery for me.
I had also brought 3d scans of my jaws and xrays which she was unable to load on her dinosaur of a computer so she never saw those in the end,but requested me to go get some more at a clinic in london which I haven't done as I probably won't be pursuing surgery with her.