Double Jaw Surgery w/ Dr. Arnett 10/4

[znewton]

did Arnett still do a sliding genio? i don't see any latch near the chin or bone cutting. the xray cuts off near the ramus. you should see a more complete xray on the wall during check ups.

No genio. Part of me wishes he did but I really can't judge my profile as I'm still really swollen. Even without it I can see a great result under all the swelling. After all, he did advance my lower jaw 16.5mm. I'm amazed at how my giant lower lip no longer folds over and seems to sit how it should. I just hope the chin comes out as the swelling comes down

[CK]

The grafting on the contour of your jawline looks great.

CK, slide the photo if you're on an iPhone.

im not, my xray shows the entire skull all the way to the spine. z's xray doesn't show all of the ramus.

No genio. Part of me wishes he did but I really can't judge my profile as I'm still really swollen. Even without it I can see a great result under all the swelling. After all, he did advance my lower jaw 16.5mm. I'm amazed at how my giant lower lip no longer folds over and seems to sit how it should. I just hope the chin comes out as the swelling comes down

from the front i think it was the right call. your chin is strong, though you are smiling (right?) so that can push it out. i had more lower jaw movement than you and my chin isn't as vertical as yours post-op. sometimes the bone doesn't always line up with the soft tissue so the surgeon has a lot of latitude when it comes to dealing with the chin during surgery.

[znewton]

im not, my xray shows the entire skull all the way to the spine. z's xray doesn't show all of the ramus.

from the front i think it was the right call. your chin is strong, though you are smiling (right?) so that can push it out. i had more lower jaw movement than you and my chin isn't as vertical as yours post-op. sometimes the bone doesn't always line up with the soft tissue so the surgeon has a lot of latitude when it comes to dealing with the chin during surgery.

Thanks, CK. I read in my operative report that at the end Dr. Arnett went over my chin and noticed that it had a "waist on it". He than made a chin incision and did some HA grafting in the area along with my jawline to fix the asymmetry I had. I have to trust that he would have done it had he thought I needed it. It's probably just still too early to tell. Also started letting the goatee (or lack thereof - was never blessed with the full beard genes) go for a bit since I was getting annoyed with shaving my numb chin. I think that makes it harder for me to tell in pictures now. Will probably shave it soon and take new pictures.

[znewton]

Three weeks post op today! Still have plenty of swelling (right still more than left) but here's the most recent before/after pic for you guys. I'm quite pleased with the results and can't wait to see how I look in a few more weeks. Hoping my lips come together at some point!

[treevernal]

I cant believe how much the swelling came down!  Youre looking great man!

[Marisama]

I second that!  Your cheekbones look great too.

[CK]

yea second on the cheek bones, no puffiness at all. pretty jealous lol. although a right profile pic would be nice when you're up to it, since that is your pre-op arnett photo that goes through the software, while the left is evaluated clinically.

really good on the cheeks tho.

[znewton]

Thanks for the comments guys. It's funny because I didn't even really notice the cheekbones until it was pointed out. Either I'm just that oblivious or don't care. Haha. Anyway, here's a pic of right to right. You can see why I've been reluctant to post it. I'm still swollen around the cheeks but the right MUCH moreso than the left. My left side is the most accurate portrait of what my result has been so far.

[CK]

Dr. A has you do an exercise where you bob your head up and down multiple times (in front of the mirror) and than stop while looking straight ahead. While doing this he's standing next to you with a frame of sorts that measures where your normally posture your head. That's how he comes up with the TVL.

Gunson doesn't do that. looking good Z. just dont fall asleep on your sides.

[Lazlo]

In all honesty, you're actually looking really, really good. Impressive result. And really glad to hear you're in good spirits and not in pain.

[Kristen]

Z ....looking good.....  R u making a blog?

[znewton]

I created one but prefer just posting updates on this thread. That's my plan for the rest of my recovery at least.

[CK]

I created one but prefer just posting updates on this thread. That's my plan for the rest of my recovery at least.

hey z ive been reading through your blog, very detailed and open. not a lot of blogs show so much detail (usually it's just before/after.)

a few questions, im just quoting what you wrote on your blog, i can remove it if you prefer:

At this point Dr. Arnett came in and took two wax bite impressions. It was extremely uncomfortable biting into the wax because I’m not used to having my back molars touch other than when I’m eating. It just felt very foreign to me and put a lot of stress on my joints. I kept the wax bite in while they took an x-ray and MRI of my face and joints. We took new profile and bite pictures after the x-ray.  Dr. Arnett than proceeded to measure my face for the next 45 minutes or so. This wasn’t bad at all except for the fact that he kept pointing out all my asymmetry. Than again, that is his job though.

We took a break for lunch and I came back about an hour later to go over all the post-surgical instructions with Kim. We finished this after about 45 minutes  and Dr. Arnett came back to go over the final treatment plan, risks, and to answer any questions I stil had at that point.

how exactly did he point out the asymmetry? how specific was he? was it more casual, or you have x, and it will be corrected by y.  and did you spend a lot of time with the assistants during the pre-op, like more than with arnett? did the assistants provide further info on what will occur during the surgery, or define potential results? if that makes sense.

did arnett go into detail on what procedures would be done - specifically - and what effect they would have? or did you have to ask first?

[znewton]

hey z ive been reading through your blog, very detailed and open. not a lot of blogs show so much detail (usually it's just before/after.)

a few questions, im just quoting what you wrote on your blog, i can remove it if you prefer:

how exactly did he point out the asymmetry? how specific was he? was it more casual, or you have x, and it will be corrected by y.  and did you spend a lot of time with the assistants during the pre-op, like more than with arnett? did the assistants provide further info on what will occur during the surgery, or define potential results? if that makes sense.

did arnett go into detail on what procedures would be done - specifically - and what effect they would have? or did you have to ask first?

CK - It's really quite hard to say and I'm sure this varies patient to patient. I can imagine some want to know more than others and have different expectations of the doctor. By the time I went in for my final records I had scoured the internet and read at least 20+ blogs from start to finish (majority being bi-max), posted on the forums, looked at before and after pictures, researched the risks, and so on. You get the point.

That being said let me answer your first question regarding how he pointed out the asymmetry - It went something like "You look like a banana head!". Sorry, I'm only kidding here but had to say it. He started examining my face and made a generalized statement that I had a lot of asymmetry. He than would mention things as he saw them - "One eye seems to be a tiny bit lower than the other (I never noticed this and dont think anybody else could but him). Some more asymmetry exists between your cheekbones. Your left is larger than the right." He than explained how the HA would even that out. That was it until he got to my lower jaw and than explained how my jaw lines were asymmetrical (right larger than left and not even) and that he would even out with the HA. He was very thorough through the entire record taking process and at making me aware of what issues existed (not solely the cosmetic ones - explained all the tilts/cants I had going on with both jaws etc.)

I'm hoping that answers your question. I prefaced this reply with that initial statement because I feel as though I walked into the office knowing what to expect. I knew that my nose could change from advancing or widening the maxilla. I was aware of potential numbness and whatnot. Hell, I had even watched YouTube videos of both a Lefort I and a BSSO. That being said, Arnett did an amazing job going over everything with me as did the assistants. Being just a little over 3-weeks post-op now I have no qualms or complaints. I didn't have exceedingly high expectations in terms of what my final result would be. My bite is now how it should have been my entire life and my facial profile is so much more balanced than it was before. I'm extremely pleased and just want the swelling on my right side to come down!

-Z-

[CK]

CK - It's really quite hard to say and I'm sure this varies patient to patient. I can imagine some want to know more than others and have different expectations of the doctor. By the time I went in for my final records I had scoured the internet and read at least 20+ blogs from start to finish (majority being bi-max), posted on the forums, looked at before and after pictures, researched the risks, and so on. You get the point.

That being said let me answer your first question regarding how he pointed out the asymmetry - It went something like "You look like a banana head!". Sorry, I'm only kidding here but had to say it. He started examining my face and made a generalized statement that I had a lot of asymmetry. He than would mention things as he saw them - "One eye seems to be a tiny bit lower than the other (I never noticed this and dont think anybody else could but him). Some more asymmetry exists between your cheekbones. Your left is larger than the right." He than explained how the HA would even that out. That was it until he got to my lower jaw and than explained how my jaw lines were asymmetrical (right larger than left and not even) and that he would even out with the HA. He was very thorough through the entire record taking process and at making me aware of what issues existed (not solely the cosmetic ones - explained all the tilts/cants I had going on with both jaws etc.)

I'm hoping that answers your question. I prefaced this reply with that initial statement because I feel as though I walked into the office knowing what to expect. I knew that my nose could change from advancing or widening the maxilla. I was aware of potential numbness and whatnot. Hell, I had even watched YouTube videos of both a Lefort I and a BSSO. That being said, Arnett did an amazing job going over everything with me as did the assistants. Being just a little over 3-weeks post-op now I have no qualms or complaints. I didn't have exceedingly high expectations in terms of what my final result would be. My bite is now how it should have been my entire life and my facial profile is so much more balanced than it was before. I'm extremely pleased and just want the swelling on my right side to come down!

-Z-

thanks for the response. i definitely entered the surgery with far less info and explanation on what would happen, and my surgery was similar to yours. maybe gunson is just quieter? i don't know. he briefly explained a CCW (after I asked), but spent most of the face time was going over the risks. in fact, most of the talking was about risks. I might move this to my own thread later, a lot more to explore but I need to look over my notes and make sure I'm not forgetting anything. It's good to know Arnett is very thorough in explaining how things will go down during the surgery.

I haven't looked to closely at your pre-op and post-op photos, but in areas where Arnett specifically pointed out where the cheek grafts were placed and HA designed to even everything out (to the best he can), can you see it yourself? Like he said your left is larger than your right, and then provides a treatment plan in addressing that. And you think so far, based on what you're seeing, the asymmetry is fixed compared to pre-op? I mean areas above the jaw, for example.

This questions may sound redundant, feel free to ignore them if you want. It is your thread after all. This really helps me a lot.