braces + lower jaw surgery or braces only?

[LoveofScotch]

Oh, Ginger, I'm sorry.

I think many of us are in the position of having to pay for a lot (if not all) of this surgery out-of-pocket. I would put "lol" after that to lighten the mood, but IT'S NOT FUNNY. I'm lucky to have really, really good insurance (which is going up another f**king 20% starting January 1, 2015), but many surgeons are out-of-network. Even if I work with someone in-network, I will still have additional cash costs.

You're welcome to send me a PM if you want more specifics.

Take care, Ginger

[Ginger]

Just an update...

I've been in braces for about 5 months. I talked with the surgeon again today since I'm still deciding on surgery. I feel like I got quite a bit more information this time around.

Lower jaw - The asymmetry of the lower jaw is obviously my main issue. From what I understand, he would move the long side back about  7 mm which would rotate my chin to center. Other side would be moved back more like 2-3 mm.

Upper jaw - I asked about the upper jaw since I have a cant, and also some downward growth/gumminess. The surgeon agreed on both counts, but said both issues are so small that it is not absolutely necessary to do upper jaw surgery. He said my cant is less than 2 mm. If we did the upper jaw, he would correct the cant and impact 1-2 mm for the gumminess.

Interesting news about the gumminess. He said I have a hyperactive upper lip. (Aha!) It makes me show a lot of gum, over 4 mm when I smile really big. If I don't do upper jaw surgery, I could calm down the hyperactive lip with botox. (I may do the lip botox soon and see what I think.)

A couple of pics below from the front to show the asymmetry. Last two pics show the gummy smile, and the last one also shows the hyperactive upper lip in action. 

I'm leaning towards surgery, at least for the lower jaw. Upper jaw... I'll need to think on that one. Might as well fix all of it?

[PloskoPlus]

A somewhat gummy smile on women is fine, as long as it's not this
http://drrichardjoseph.com/photos/121.php

Impaction can be aging. As others have told you here you have a great face.  I would only do very conservative movements to fix things at the occlusion level, but nothing that would drastically change the way you look.  Make sure your surgeon communicates exactly what he will do and what the expectations should be.

BTW, does your bite really bother you that much?

[terry947]

This is such a random question but do you have scoliosis or any postural issues?

[Ginger]

A somewhat gummy smile on women is fine, as long as it's not this
http://drrichardjoseph.com/photos/121.php

Impaction can be aging. As others have told you here you have a great face.  I would only do very conservative movements to fix things at the occlusion level, but nothing that would drastically change the way you look.  Make sure your surgeon communicates exactly what he will do and what the expectations should be.

BTW, does your bite really bother you that much?

Plosko, thanks for your, as always, valuable input. I definitely agree with you on conservative movements.

My bite does bother me quite a bit. Weird angled pic below, but it shows my bite wonkiness. Some front teeth are edge to edge and the rest are in full underbite mode. The asymmetry of my jaw causes the midline to be pushed over to the left, and the left molars are going into a crossbite. The asymmetry also causes a lot of pain in the left TMJ joint.

P.S. That Dr. Joseph patient looks fantastic afterwards. I love his aesthetic.

[Ginger]

This is such a random question but do you have scoliosis or any postural issues?

Not really. I have some neck issues, which sucks, but seems to pretty common for people jaw issues.

I think you mentioned in another thread that you have some neck issues?

[terry947]

Not really. I have some neck issues, which sucks, but seems to pretty common for people jaw issues.

I think you mentioned in another thread that you have some neck issues?

ya I believe that theres a connection with jaws and postural issues.

[Ginger]

ya I believe that theres a connection with jaws and postural issues.

I think you're on to something there. If someone's has forward head posture because of breathing issues, jaw pain, asymmetry, etc, their neck muscles have to work differently than normal, which can cause neck pain and strain on other back muscles. A lot of chain of events going on there.

This is from some TMJ clinic but they do a nice job of explaining how the jaw effects overall posture:
http://www.portlandtmjclinic.com/tmj-disorders/the-role-of-body-posture

P.S. Now that I think about it, my head is probably more forward than it should be...

[Ginger]

Thanks Phantom. I didn't even think about impaction causing nose changes! That's really something to consider. My nose already tilts up a bit... it would probably look weird tilted up more.

Thanks for the compliment on the pic. Maybe my cheeks add a bit of sweetness to my face.

And yes, I also have some Irish like you

[Ginger]

Botox for gummy smile -- I was looking into it as an option for my upper lip. From most pics I've seen so far, it looks kinda weird and makes the philtrum look longer. I don't need mine to look any longer.

Pic below from a New York Times article....

[attachment deleted by admin]

[PloskoPlus]

Your upper lip will only lengthen with age.  So I'd be super conservative with any impaction.

[Ginger]

Your upper lip will only lengthen with age.  So I'd be super conservative with any impaction.

True. I've read the upper lip lengthens about a millimeter a decade starting around age 40.

[Ginger]

Just an update. I'm still a few months away from lower jaw surgery. I've decided not to mess with the upper jaw impaction. I don't think the small amount will warrant going through upper jaw surgery (2-2.5mm). Also, I don't want to mess with any nose changes. If my gumminess still bothers me later, I can get some botox or lip lowering surgery.

If anyone's interested, here's a youtube video that shows a patient before and after lip lowering surgery. It also shows her stitches so you can see where the lip is positioned: 
https://www.youtube.com/watch?v=y7IYyfffgOs