Double Jaw Surgery w/ Dr. Arnett 10/4

[CK]

In terms of asking questions - after he did his 3rd check of all the measurements he sat down next to me to go over all the procedures and risks. We did that verbally than went over a checklist of what we had just discussed so I was sure he had covered all his bases. I took this as an opportunity to ask questions which he politely answered without hesitation. I don't think I really had that much to ask though compared to other patients.

 that's good. verbal checklist, smart. seems like you are well-informed and have a good handle on the surgery.

[znewton]

Here's my initial CPT that was done 14 months ago verus the final treatment plan Dr. Arnett came up with yesterday. I saw him today briefly while stoppin by to meet with one of the assistants. He said he's probably going forward with the genio. So that's a 16mm advancement of the lower jaw in addition to a 2mm genio. He said overall the total movement of "Pog" (which I believe is right under your bottom lip) would be 20mm. (Yes, TWENTY!) I told him that number seemed large and I was a bit concerned, and he reassured me I will look great. I know that has to be what he tells all his patients, but after thinking about it a bit more I'm not worried. I'm not the doctor and am solely anxious based off of other numbers I've read on random blogs. I'll be sure to post pictures for you all!

[treevernal]

Here's my initial CPT that was done 14 months ago verus the final treatment plan Dr. Arnett came up with yesterday. I saw him today briefly while stoppin by to meet with one of the assistants. He said he's probably going forward with the genio. So that's a 16mm advancement of the lower jaw in addition to a 2mm genio. He said overall the total movement of "Pog" (which I believe is right under your bottom lip) would be 20mm. (Yes, TWENTY!) I told him that number seemed large and I was a bit concerned, and he reassured me I will look great. I know that has to be what he tells all his patients, but after thinking about it a bit more I'm not worried. I'm not the doctor and am solely anxious based off of other numbers I've read on random blogs. I'll be sure to post pictures for you all!

Interesting that your head tilt changed.  The TVL was originally 10mm from glabella now its 6mm.  Def a sign that you werent tilting your head upwards as much this time around.  Also interesting that hes not advancing the TVL afterall.  Its amazing how much decompensating the upper incisors orthodontically will change the treatment plan.

[znewton]

Interesting that your head tilt changed.  The TVL was originally 10mm from glabella now its 6mm.  Def a sign that you werent tilting your head upwards as much this time around.  Also interesting that hes not advancing the TVL afterall.  Its amazing how much decompensating the upper incisors orthodontically will change the treatment plan.

What do you mean by TVL? He took the measurement for my head posture two separate times and initially I was closer to the first ceph, but ended up at -6 by the end of it.

[treevernal]

TVL is the "true vertical line" in your ceph tracing that runs through subnasal.

[znewton]

true vertical line.

for your genio, like i said, he'll run it through the virtual surgical planner, sort of like this:

http://www.dolphinimaging.com/3dsurgery.html

first image, but profile of your skull - right side i believe - and no soft tissue.

it basically guarantees the hard tissue will be aligned (your bite), and is a strong aid in designing soft tissue/aesthetic treatment, but imo it's more beta-like for soft tissue because i dont think dolphin - yet - can control for different types of soft tissue for individual patients, or even recognize a range. so the genio looks strong bone-wise, from a computer, but it may look different in RL depending on how your skin is. though the chin area tends to be the most bony at least from what i've seen so it isn't usually a problem. the sliding genio doesn't alter the symmetry of your chin, it just lengthens it in whichever direction the surgeon determines. i dont know what version of dolphin they use, or if it used to this kind of extent:

http://www.dolphinimaging.com/3dimages/digitize_big.jpg

the riskier variables imo lie in the mid-upper face, and really boils down to the clinical analysis of the surgeon.

Thanks for the clarification! I almost forgot - one thing that really surprised me is that I will not have a split despite the fact that he is segmenting my upper jaw. Are your skeletal screw and hook still in CK? I'm curious what it will be like to see a phillips head exposed right above my teeth!

[CK]

Thanks for the clarification! I almost forgot - one thing that really surprised me is that I will not have a split despite the fact that he is segmenting my upper jaw. Are your skeletal screw and hook still in CK? I'm curious what it will be like to see a phillips head exposed right above my teeth!

you mean a splint? you'll have a splint, but it is taken out after the operation. if you request your VSP records, there should be a page that shows pre-op, mid-op (with splint), and final bite.

all my screws/hooks/latches/plates are still in. i cant see it or really even feel it. only way i know is when looking at an xray. i read some former patient said she could feel the screws getting cold if it was really chilly, but i havent had that problem.

it isn't that big of a deal. did arnett go over the HA and its vulnerability - i.e, dont sleep on the side of your face? or sleep on your face at all basically...because if the HA does flatten i was told they can't do much about it.

[znewton]

you mean a splint? you'll have a splint, but it is taken out after the operation. if you request your VSP records, there should be a page that shows pre-op, mid-op (with splint), and final bite.

all my screws/hooks/latches/plates are still in. i cant see it or really even feel it. only way i know is when looking at an xray. i read some former patient said she could feel the screws getting cold if it was really chilly, but i havent had that problem.

it isn't that big of a deal. did arnett go over the HA and its vulnerability - i.e, dont sleep on the side of your face? or sleep on your face at all basically...because if the HA does flatten i was told they can't do much about it.

Yes, I meant splint. When referring to the skeletal screws I was referring to the ones that are exposed which are used to secure the front elastic. Did he not use those with you? I'm not worried about all the other hardware/plates/etc and feeling those. I'm just curious what the front hook and elastic (which are exposed) feel like.

He did go over the HA grafts with me as did the assistant. He explained how critical it is to stay upright and on my back when the time comes. The assistant mentioned if I did end up flattening one side that he would simply have to do the same to the other side. Essentially, they can even it out but I'd lose the effect he was originally going for. I just plan on being hyper-aware and doing my best to not mess things up 

[CK]

Yes, I meant splint. When referring to the skeletal screws I was referring to the ones that are exposed which are used to secure the front elastic. Did he not use those with you? I'm not worried about all the other hardware/plates/etc and feeling those. I'm just curious what the front hook and elastic (which are exposed) feel like.

oh, you mean the hooks? yes, you have to have hooks to loop the bands. it all depends on the patient. you may not even use the front hook, just the sides. it all depends, you'll wake up after surgery and know where your bands are. they dont feel like anything, you'll be so numb it will be the last thing on you mind.

He did go over the HA grafts with me as did the assistant. He explained how critical it is to stay upright and on my back when the time comes. The assistant mentioned if I did end up flattening one side that he would simply have to do the same to the other side. Essentially, they can even it out but I'd lose the effect he was originally going for. I just plan on being hyper-aware and doing my best to not mess things up 

yeah, that's what sucks. plus, even if they do even if it out, im not sure if you can have it re-do without scrapping off the original HA. it can really influence the aesthetic result so i would be very mindful of how you sleep. i slept at a 40-50* angle for two months. let us know if arnett molds your cheek grafts afterwards.

 

[CK]

Yeah, someone answer this please. Sounds like a very stressful thing to try and not roll in your sleep or something stupid to screw it all up.

8 weeks.

[dayeangphurr]

Whoa, its creepy how your profile in the recent CTP looks a lot like my profile (especially with how the lower lips hang, along with how far apart the lips are from each other when relaxed, and the chin) LOL. Also, even creepier, I checked out your most updated post on your blog where you included a picture with the various photographs of you on the board; I, seriously, felt like I was looking at myself from afar - is this what it feels like to be looking at a doppelganger? I find this eerie, fascinating, and humorous all at once haha.

Man, I better brace myself for when I start orthodontics and my bite and profile begins to change (for the "worse") in preparation for surgery - I can barely handle the look of my current profile. Although, I won't be starting braces for another year or two.

Anyways, 1 more day til the big day for you; best of wishes to you, znewton.

[znewton]

Thank you to everyone for all the encouragement! I've gotta say I was a bit surprised at how many people have chimed in here. In addition to posting on here I've received a few e-mails as well wishing me luck for surgery. At this point I'm just about 24 hours from surgery. I'm going to the Zoo in Santa Barbara since I don't have much left to do today. I have to check out of my hotel at 10 and the rental property I reserved isn't available until 3:00PM. I think the last time I was at a a zoo was 10-15 years ago in San Francisco (my hometown). Than again, I did summit Mt. Kilimanjaro seven years ago which included plenty of animal sighting that obviously trumps a zoo!

Ok, that's enough ranting for now - probably stemming from pre-surgery nerves! Also wanted to say I'm looking forward to sharing my surgery and recovery with all of you. I will be sure to post and take pictures as often as I can. I've gotta figure out the logistics about that though. My stepmom (who will be my primary caretaker along with my father for these first five days in SB) who is the sweetest woman ever, might be taken back if I asked her to tae pictures of me in all my glory right out of surgery. We'll see.

I"ll post later on today.

[CK]

definitely take some photos, gunson didnt seem to mind. especially when you first wake up, it's cool to look at them months later.

arnett is probably the same.

[Antbee]

Just to clarify, znewton means the hook (not in braces) and the Phillips-head screw that are embedded in the gums above and below the teeth. This girl who had surgery with Gunson had them:
http://ashleysjawsurgery.wordpress.com/
I think I'm having them too. (I'm Arnett's next surgery after znewton next week).
CK did you have these and if so did you have them removed yet?

[CK]

Just to clarify, znewton means the hook (not in braces) and the Phillips-head screw that are embedded in the gums above and below the teeth. This girl who had surgery with Gunson had them:
http://ashleysjawsurgery.wordpress.com/
I think I'm having them too. (I'm Arnett's next surgery after znewton next week).
CK did you have these and if so did you have them removed yet?

yeah i believe i had the hooks that are trapped in the gums lol. definitely did not like them at all. i had them removed awhile ago.

congrats on your surgery antbee!